Medication

Medication Error
Medications are the most frequently prescribed treatment interventions in healthcare. Even though medication can be very useful, errors that are preventable occur that can cause these medication to cause adverse effect and eve nbecome lethal. Medication errors have a high cose not only for patients but economically as well. The Institute of Medicine (IOM) stated that up to 7,000 Americans are killed due to medication errors every year both in and out of the hospital (Institute of Safe Medication Practices, 2000). The Institute of Safe Medication Practices (ISMP), IOM, and Food and Drug Administration (FDA) beleive that swapping hand written paper prescriptions for Electronic Health Records (EHR) will decrease the number of medication errors dramatically. A quasiexperimental study conducted by the University of Washington concluded that with the use of a Computerized Provider Order Entry (CPOE) system the frequency of errors has declined from 18.2% to 8.2% (Devine et a., 2009).

In-case of Emergency EHR Knows your Medications

Drug Interactions
Medications are one of the most widely used intervention, that along with their advantages comes an estimated 1.5 million adverse drug events whose key cause are preventable of drug-drug interactions (DDIs). A DDI is deemed when “the effectiveness or toxicity of one medication is altered by the administration of another medicine or a substance that is administered for medical purposes (to be distinguished from drug-food interactions)”. Many of the interactions that occur can be predicted based of the properties and administration method of the drug according to the patient-specific parameters. One of the most important steps in regards to appreciating electronic prescribing in correlation to patient safety is the implementation of definitive DDI checking (Classen, Phansalkar, & Bates, 2011).

Decreased Medication Interactions These DDI checks were typically done by the pharmacist using the pharmacy computer systems when the order was being dispensed. This was a down fall in one the stages in medication administration; the pharmacist would discover the DDI and would have a hard time consequently reaching the doctor, causing a delay, and because the pharmacist may not have enough health information about the patient, the order would be left unresolved until further notice. With the implementation of EHR the checking of DDIs is being adapted by physicians through Computerized physician order entry (CPOE). Since the physician and pharmacist both conduct “checks”, essentially conducting a double check. Within these programs there are various DDIs that are identified by the institute that produce an alert if an interaction occurs with drugs that the specific patient is prescribed, this is also where the struggle also occurs. Institutes often find it difficult to determine which interactions to display; too many displayed interactions can cause alert fatigue and even underlying system rejection (Classen, Phansalkar, & Bates, 2011).

Medication Prescription
Inappropriate medications are prescribed to people of all age groups many times, but this potentially inappropriate medication (PIM) prescriptions can be detrimental to the elderly population. Some examples of PIMs are medications that have specific age-related or genetic-profile contraindications, and those that can be potentially harmful (drug-dry/ drug-allergy interaction). A tool that is recognized widely is the Beers criteria which assess the quality of prescribing in the elderly population. The 2002 Beers criteria includes 48 individual medications or classes, along with 20 diseases/conditions and the medications to be avoided with these 20 conditions in elderly patients. This criteria suggests the integration of recommendations into HER and CPOE as a strategy in enhancing the practice of prescribing medications. This would improve the practice by allowing the prescription to be documented regardless of where, when or how the prescription was filled, leading to a decrease in PIM incidences. A 4 year quality improvement project designed to decrease the incidences of PIM prescribing found through the use of EHR, patients prescribed “always inappropriate” medications decreased prevalence from 0 .41% to 0 .33% and with "rarely appropriate" medications a decrease was seen from 1.48% to 1.30% (Buck et al., 2009).

Medication Information
In the past the extent of information that was given to the patient when being prescribed medication was the name of medication, route and timing of when to take it. The execution of EHR in primary healthcare settings provides potential to decrease and one day eliminate medication inconsistencies along with providing patient teaching through delivery of medication information. By providing this information to patients will improve medication safety and adherence. The information given to patients was written in a way that is understandable to a wide range of people by using plain language medication information sheets that can be printed out using the EHR for when a new medication has been prescribed. To keep the EHR up to date, when the patient checks in for the physician a list of medications is printed out as a way for the patient to identify whether there are any duplicate medications or medications that are no longer prescribed. There is also a section where patients can state any concerns that they may be having in regards to adverse effects, prescription refill, cost or others, along with a section where medications not on the list can be added (over the counter medications, vitamins/supplements). This sheet is found to be a great tool in helping physicians with eliminating any discrepancies (Webb et al., 2010).