Adverse effects of medication
A separate emergency center for older patients includes physical features to reduce anxiety and discomfort, staff trained in geriatric care, and routine followup monitoring after discharge, leading to high levels of patient satisfaction, detection of polypharmacy, increased patient volume, and a low rate of return visits.
Clinical pharmacists working in 13 community health centers provide medication reconciliation, monitoring, dosage adjustments, and education to high-risk patients, including those with severe diabetes and those on anticoagulants.
The West Los Angeles Healthcare Center implemented a program to improve nurses' and patients' awareness and reporting of medication allergies and adverse drug reactions. Key program elements include a training module for nurses, educational brochures for patients, and distribution of an allergy/adverse drug reaction questionnaire to patients.
Safety mentors at Christiana Care Health System help staff implement best-practice safety behaviors and reporting of errors and near misses, leading to a reduction in serious adverse events and increased identification and/or reporting of near misses.
The Mayo Clinic Department of Medicine developed a computer-generated, customized medication education and reminder card for patients discharged on multiple medications; the card was tested as an alternative to the medication discharge worksheet commonly used by nurses at Mayo.
Contra Costa Health Services launched a medication reconciliation process at its county-owned hospital based on Institute for Healthcare Improvement concepts for redesigning work to achieve a high degree of reliability. The institution uses a process in which providers, pharmacy, and nursing staff have standardized, easy-to-understand, and easy-to-execute roles related to medication reconciliation.
Reconciling patient and provider medication lists reduces discrepancies, leading to enhanced medication safety and high levels of patient and provider satisfaction in the outpatient setting.
The University of Rochester Medical Center placed a clinical pharmacist in the emergency department to serve as an integral member of the health care team, leading to an increase in quality care.
Kaiser Permanente Colorado developed a computerized alert system to notify pharmacists when elderly patients are prescribed potentially inappropriate medications; alerted pharmacists consult with the physicians to discuss the prescription, leading to a reduction in inappropriate prescribing.
A hospital implemented a medication reconciliation process, the cornerstone of which is a one-page structured form that nurses, physicians, and pharmacists use to list all medications taken by the patient at home, confirm the continuation of existing medications, order newly prescribed medications, and facilitate medication reconciliation during patient transfers and at discharge.