Health system is first to automate drug info

Fauquier Health System of Warrenton, VA, has announced that it is the first health system in the nation to pilot a system that will improve patient safety by automatically incorporating a patient's current prescription information into the hospital environment.

While some hospitals are beginning to use internal electronic medical reconciliation, Fauquier will be the first to also track external records, says Cathy Walsh, RN, director of quality and risk management. She says the system should help reduce the risk from incomplete or inaccurate medication histories.

"Patients are not very good historians regarding their medications. They often say, 'I take one of the blue pills and two of the green pills,'" Walsh says. "That can lead to medication errors, and like many providers, medication errors were one of our most common incidents. From a risk perspective, the opportunity to collect better data and not rely on the patient's memory is really key."

Donna Staton, MS, chief information officer of Fauquier Health System, says she and her colleagues were looking for a way to improve medication reconciliation, partly in response to mandates by The Joint Commission, when they came upon this new approach. She was familiar with physicians using a similar concept in an outpatient setting but not for acute care.

Staton notes that inconsistent medication knowledge and record keeping threaten patient safety by causing up to 50% of all medication-related errors in hospitals and up to 20% of all adverse drug events. Beyond the toll on an individual's health, a 2006 Institute of Medicine study found that each preventable adverse drug event that took place in a hospital added $8,750 to the cost of a hospital stay.

"This is a very significant first as drug errors are causing a national health care challenge. When patients arrive in an emergency department they or their families often can't recall all the medications a patient is taking," she says. "This can open the door for drug interactions or duplicative prescriptions."

Fauquier is implementing the system in stages, beginning with scheduled surgery patients. The system begins when surgery is scheduled and a nurse preregisters the patient. The nurse collects medication information from the patient but also uses the automated system to look for current prescriptions. Information about a prescription can be used during the interview process. For example, the nurse might say, "We see a prescription for a statin here, one pill a day. Are you still taking that medication, and do you take it that way?"

Walsh and Staton say the new system is not a replacement for asking the patient about medication but it provides more information that can enhance the information. Fauquier Health System is working with DrFirst of Rockville, MD, to implement the patient safety initiative. DrFirst has relationships with several pharmacy benefit management groups and pharmacy databases that allow it to compile information on most patients' medications. Walsh says there currently is about a 60% chance the patient's medication information will be in the system, but more databases are being added and that figure may rise to 90% by the end of 2007. Access to the information is allowed under the standard consent to treat, Walsh says.

Staton and Walsh approached the company with the idea of applying the medication reconciliation system to acute care, and then Fauquier worked closely with the company to develop the product and begin testing. DrFirst's Rcopia electronic Acute Care medication reconciliation (RcopiaAC) compiles a Fauquier patient's current prescriptions from various prescription history databases so that any potential new medications can be compared to limit drug interactions. Then, at the end of a patient's stay, this list is reviewed again to help ensure that any prescriptions made at the time of discharge are also without complications, such as duplicative therapy and interactive medications. The prescription information also is provided to the patient and can be electronically accessed by the patient's regular physician to ensure a continuum of care.

Another added safeguard through RcopiaAC is the e-prescribing feature that allows physicians to issue electronic prescriptions, thus avoiding yet another common source of drug errors: poor physician handwriting.

Fauquier first started talking about the concept last year and began the pilot program in June with a subset of patients: preoperative testing and scheduled surgery patients. Surgeons began participating in the process for discharging patients on Aug. 7. More patients will be folded into the system as the pilot program continues.

Because Fauquier helped develop the system with DrFirst and is piloting the program, the health system pays only a minimal fee. The pricing structure for other providers is in development, according to Irene Froehlich, director of marketing for DrFirst. The RcopiaAC drug reconciliation system can be used standalone or interfaced with the hospital's existing systems, she says.

"The price for electronic medication reconciliation depends upon the service package, and size of the hospital based upon the number of beds," she says.

Fauquier has not had enough time to compile hard data showing results of the pilot program, but Staton and Walsh say they expect to see measurable results.

The clinicians are excited about using the system and encouraged by the efficiencies it can bring, Walsh says. "Anything that helps them avoid these medication errors is going to be welcomed as long as it really works, and our first impression is that this does work," she says.


For more on the drug reconciliation system used by Fauquier Health System, contact:

Joint Commission: Report concerns — no retaliation

Physicians and medical staff members who have concerns about the safety and quality of care at their hospital may report those concerns with the understanding that retaliatory disciplinary action is prohibited, according to explicit new rules announced by The Joint Commission. The accreditation participation requirement previously referred generally to hospital staff.

The revised requirement becomes effective Jan. 1, 2008. Accredited hospitals must educate staff and medical staff that any employee or any physician who has concerns about the safety or quality of care provided in the hospital may report those concerns to The Joint Commission and that no disciplinary action will be taken.

Anyone who has concerns about the safety or quality of care at an accredited organization may share those concerns with The Joint Commission Office of Quality Monitoring by phoning (800) 994-6610 or by sending an e-mail to