Statewide Programs Should Track All Prescriptions, Not Just Opiates

To help reduce outpatient medication errors, policymakers should expand prescription drug monitoring programs to include all medications instead of opiates alone, suggested an article in The American Journal of Managed Care.

Their call for statewide medication reconciliation programs aims to help outpatient providers accurately verify what drugs their patients are taking — a task they categorize as important yet “deceptively simple.”

“In our clinical practice, the peeved patient will say to us, ‘I take a white pill, a brown pill, and a little blue pill. I don’t know what the names are, doc. Don’t you have that in the computer?’” Elisabeth Askin, MD, and David Margolius, MD wrote.

The success of prescription drug monitoring programs in reducing erroneous opiate prescriptions suggests such programs could be equally effective for all medications, they add. 

Patient encounters with specialists, hospitals, and pharmacies can change a patient’s medication list without the necessary communication back to the primary care provider’s office and updates to the patient’s electronic health record, the authors explain. They went on to cite research that suggests electronic health record medication lists are often incomplete or incorrect.

“In a 2015 study of emergency departments, only 21.9% of medication lists matched what the patient took at home, and in a 2014 study of primary care clinics, only 15% matched,” they wrote. “Another study looking at hospital discharges found that 81% of adults 65 years or older either were subject to a provider error in their medication list or were unaware of at least 1 medication change having taken place.”

The authors proposed a single-source, electronic, master list that all health systems, prescribers, and pharmacies in the state could access. It would include all medications a patient is currently taking, as well as a history of what the patient has taken in the past. The program would be intuitive, easy to use, and interoperable with individual health systems’ electronic health record programs to avoid extra work for providers.   

A patient portal would also be included to allow patients to see their current medication list and potentially act as active collaborators in keeping it accurate, they added.

“Prescription drug monitoring programs show us that the registry and formation of a database is realizable,” Dr Askin and Dr Margolius concluded. “Now is the right time for action.” —Jolynn Tumolo