What makes a medication meaningful? I suppose that ANY medication that is prescribed to a patient should be meaningful, but what happens when a patient’s medication list is maintained on the EHR, but the list isn’t accurate? Would an incomplete or inaccurate list be meaningful to anyone?
Let’s for a moment suspend the idea of a medication’s “usefulness” to the patient and examine the “meaningfulness” of the medication’s inclusion on the medication list. Perhaps the best way is to present a few patient scenarios:
Let’s for a moment suspend the idea of a medication’s “usefulness” to the patient and examine the “meaningfulness” of the medication’s inclusion on the medication list. Perhaps the best way is to present a few patient scenarios:
Patient Scenario One
Patient One, “Mary Meaningful,” visits a clinic because she has allergy symptoms. She currently takes an over-the-counter decongestant, as well as a few vitamins and supplements. She also takes an anti-anxiety medication that she asks not be included on her medication list. Not wanting to cause Mary any distress, the nurse records her medications in the system (absent the anxiety medication) and sends her on to see the provider. Mary doesn’t mention anything about the anxiety medication to the provider because she feels embarrassed that she is taking it. The provider feels sure the medication list is accurate because it has been reconciled by the nurse and prescribes Mary an antihistamine.
Do you see the potential hazard here?
Dangerous interactions can occur when antihistamines and anti-anxiety drugs are taken together.
Patient One, “Mary Meaningful,” visits a clinic because she has allergy symptoms. She currently takes an over-the-counter decongestant, as well as a few vitamins and supplements. She also takes an anti-anxiety medication that she asks not be included on her medication list. Not wanting to cause Mary any distress, the nurse records her medications in the system (absent the anxiety medication) and sends her on to see the provider. Mary doesn’t mention anything about the anxiety medication to the provider because she feels embarrassed that she is taking it. The provider feels sure the medication list is accurate because it has been reconciled by the nurse and prescribes Mary an antihistamine.
Do you see the potential hazard here?
Dangerous interactions can occur when antihistamines and anti-anxiety drugs are taken together.
Patient Scenario Two
Patient Two, “Mike Meaningful,” shows up for his annual Medicare visit. He reports to the nurse that he has been seeing one of the cardiologists for some heart-related issues and that he was prescribed some medications a few months ago. She pulls up his chart and doesn’t see any medications on the list. When she questions Mike, he tells her that the doctor was too busy at his appointment and didn’t have time to put them in the system. He just wrote them out on prescription paper.
How meaningful is the medication list now?
One provider’s responsibility has now been pushed off to another provider’s clinical staff, and, consequently, takes more time and is potentially less accurate than using the system the way it was designed.
Patient Two, “Mike Meaningful,” shows up for his annual Medicare visit. He reports to the nurse that he has been seeing one of the cardiologists for some heart-related issues and that he was prescribed some medications a few months ago. She pulls up his chart and doesn’t see any medications on the list. When she questions Mike, he tells her that the doctor was too busy at his appointment and didn’t have time to put them in the system. He just wrote them out on prescription paper.
How meaningful is the medication list now?
One provider’s responsibility has now been pushed off to another provider’s clinical staff, and, consequently, takes more time and is potentially less accurate than using the system the way it was designed.
Patient Scenario Three
Patient Three, “Misty Meaningful,” was originally prescribed 25mg of a blood pressure medication by her primary care physician, which was ordered through the system correctly. A few weeks later, Misty’s blood pressure hasn’t improved so the clinic calls in a higher dosage—50mg—but doesn’t record the change in the patient’s chart. Misty visits her specialist, who sees the dosage is 25mg but knows she is taking 50mg, as she reported to him. He decides she needs to take 100mg, and renews the medication at the higher dose. Unfortunately, Misty has a bad reaction and files a malpractice suit. When the defense attorney reads the specialist’s note, it appears that he upped her dosage by 75 mg because no one recorded the 50mg.
Where does the fault lie?
Obviously, no one could have predicted the bad reaction, but how can we rely on the accuracy of a medication list and the system’s ability to accurately reflect a provider’s plan when no one takes the time to document in the EHR?
Meaningful Medications = Better Patient Care
I could describe many more patient scenarios in which the lack of accurate medication documentation has caused problems, but I think you get the point. Even when clinics were on paper, keeping an up-to-date medication list was very important for good patient care, but now, with the transition to an electronic health record, and with multiple providers using the same chart, each user must be particularly careful to accurately document. If we strive to make the medication list truly meaningful, the end result can only mean better patient care.
Patient Three, “Misty Meaningful,” was originally prescribed 25mg of a blood pressure medication by her primary care physician, which was ordered through the system correctly. A few weeks later, Misty’s blood pressure hasn’t improved so the clinic calls in a higher dosage—50mg—but doesn’t record the change in the patient’s chart. Misty visits her specialist, who sees the dosage is 25mg but knows she is taking 50mg, as she reported to him. He decides she needs to take 100mg, and renews the medication at the higher dose. Unfortunately, Misty has a bad reaction and files a malpractice suit. When the defense attorney reads the specialist’s note, it appears that he upped her dosage by 75 mg because no one recorded the 50mg.
Where does the fault lie?
Obviously, no one could have predicted the bad reaction, but how can we rely on the accuracy of a medication list and the system’s ability to accurately reflect a provider’s plan when no one takes the time to document in the EHR?
Meaningful Medications = Better Patient Care
I could describe many more patient scenarios in which the lack of accurate medication documentation has caused problems, but I think you get the point. Even when clinics were on paper, keeping an up-to-date medication list was very important for good patient care, but now, with the transition to an electronic health record, and with multiple providers using the same chart, each user must be particularly careful to accurately document. If we strive to make the medication list truly meaningful, the end result can only mean better patient care.
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