Project gives nurses quick access to patient meds

  • A woman found unconscious by co-workers.
  • An elderly man who says he takes several medications, but he can’t recall the names or dosages.
  • A teenage girl critically injured in a motor vehicle accident.

What do all these patients have in common? The lack of ability to obtain an accurate and complete list of all the medications they’re taking. As participants in the MedsInfo — ED project program, ED nurses at Emerson Hospital, Boston Medical Center, and Beth Israel Deaconess Medical Center, all in the Boston area, can obtain this information within seconds. The project is a collaboration of health plans, hospitals, pharmacy benefit managers, technology vendors, and Massachusetts state agencies with the goal of improving patient safety.

"In the ED, I see patients on a daily basis who have been prescribed more pills than they could possibly remember," says Larry A. Nathanson, MD, director of emergency medicine informatics at Beth Israel. "Given the unplanned nature of emergencies, patients often arrive in the ED without a complete medication history available."

In addition, patients may have altered mental status, ranging from mild confusion to comatose, which makes it impossible to obtain an accurate medication history.

"With ambulance diversion and ED overcrowding reaching critical proportions, it is common to see patients with no previous records immediately available to me," says Nathanson. "Knowing what medications the patient is taking can provide immediate insight into their medical history, as well as allow confidence that any medications I might give them won’t cause an interaction."

If patients are unsure of their medications or doses or are unconscious, an encrypted application is used to enter information, so triage nurses can view a list of the patients’ prescriptions that have been filled by any pharmacy, based on insurance records.

Special care is taken to protect this and all other types of electronic personal health care data, emphasizes Nathanson. MedsInfo has specific rules governing who may access this information and when: Either the patient must give permission, or the attending physician must certify that a medical emergency exists that prevents the patient from being able to do so, he says. "The information is password protected and encrypted during transmission, and all usage is logged and reviewed," says Nathanson.

The program ensures compliance with one of the National Patient Safety Goals from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) that requires you to reconcile a patient’s medications across the continuum of care.

"This goal is challenging for EDs because they often lack information about medications a patient is currently taking," notes Nathanson.

Once obtained, the patient’s current medication list can be compared to other documentation such as previous discharge summaries. Duane A. Young-Kershaw, RN, BSN, clinical nurse educator for the ED at Beth Israel, says, "We also can compare the list to medications the patient brings in, and we can look at issues such as compliance and availability of the medication to the patient."

ED nurses know the medication name, date dispensed, dosage form, quantity, class, and prescriber — information that can significantly impact the care a patient would receive, says Young-Kershaw.

The patient may be critically ill and unresponsive, with no one to provide medical information. "Having the medication list would not only tell us what the patient is taking, but also give us a clue to their past medical history," he adds. "Similarly, if a patient is unresponsive, we could look at their meds combined with the date of dispense and find any possible culprits that the patient could have overdosed on."

Sources

For more information, contact:

  • Larry A. Nathanson, MD, Director of Emer-gency Medicine Informatics, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston. Telephone: (617) 754-2389. E-mail: LNathans@bidmc.harvard.edu.
  • Duane A. Young-Kershaw, RN, BSN, Clinical Nurse Educator, Emergency Department, Beth Israel Deaconess Medical Center, Boston. Telephone: (617) 754-2310. E-mail: dyoungk@bidmc.harvard.edu.