When it comes to medication safety, the discussion extends beyond just how, where or when we take medication – but whether medication is being taken at all.
Next week, the Canadian Patient Safety Institute is hosting its annual Canadian Patient Safety Week, a campaign to raise awareness around patient safety and quality. This year’s theme is Medication Safety.
While I often discuss and present on issues of patient safety and privacy in eHealth – medication safety in the era of automation and technology is one domain where the potential for error is most concerning. To illustrate just what can go wrong, even when we as clinicians have no clear reason to be concerned, I’d like to tell the story of a specific patient experience I had while working on the front lines of healthcare. As it turns out, the situation is far from unique.
I had a very conscientious patient who came to see me every month – always at the right time – to review his hypertension and to adjust his medication. The patient was a recent widower after his wife died about five months earlier. He seemed to be coping well in spite of his loss. At our last consultation, I noted that his blood pressure was elevated, at around 165/ 105 mmHg. We discussed what to do, and he seemed appropriately concerned. He was already taking three medications for his hypertension plus low dose aspirin. We agreed to double his ACE inhibitor medication dose and for him to return to see my nurse in a week’s time for closer monitoring.
Unfortunately, my next contact with him came when the police phoned and asked me to confirm that I was his physician, and to come to his house to certify him as deceased. He had suffered a fatal heart attack. When I went to his house, I discovered a medicine cabinet full of unopened medications. He had been going to see me regularly and the pharmacist, picking up and filling his prescriptions, but not ultimately taking them!
The breakdown in the journey between when a doctor prescribes a medication and when a patient takes the medication is far more prevalent than one might believe. In Canada, 600 million prescriptions are issued each year and 30-40 per cent of those are never filled at all. A large proportion of those not taken are likely to be for cost saving reasons.
Typically, patients will leave off the most expensive medication, or have a short discussion with the pharmacist and leave off a medication that does not seem important. This is especially fraught if the pharmacist does not have access to the patient’s summary of care and care plan.
At Orion Health, our mission is to keep the patient at the centre of their care. We develop technologies that give the entire care team (including pharmacists and all other involved providers) access to a patient’s care plan, so decisions are made on the basis of that care plan.
The question then becomes – how can we close this medication gap?
We are focused on building and appropriately sharing clinical records that include fully coordinated care plans to empower patients, their families and the entire care team. We’ve successfully implemented this approach at a number of sites including New Zealand, the UK and USA. As an example, in Canterbury, New Zealand, the Medication Management Service solution is deployed in support of medication workflows. The pharmacist, patient and the patient’s family assess the patient’s adherence to their care plan. Finally, using these tools, doctors can provide recommendations to the patient, their family and their caregivers to improve understanding and ensure adherence to the prescribed medications.
The best practice approach is threefold:
- Timely, safe and effective review of medications
- Inclusion of the patient and their circle of care in the process
- Tracking of the medications
Such an approach will enhance patient safety by closing the loop on the journey from the prescription to the patient. Medication can save lives – though only if it’s taken as intended, and if the physician, pharmacist and all others involved clearly understand the patient’s clinical situation, have access to the care plan and can easily communicate amongst the circle of care if something is amiss.