February 17, 2010


Saving the Elderly With Medication Reconciliation

A recent British study published in the Oxford Journal states, “the average rate of Adverse Drug Reaction (ADR) related hospital admissions is 16.6% in the elderly compared to 4.1% in younger patients, with 88% being preventable.”

This study raises a few obvious questions:
  • Why are the elderly 4 times more likely to experience an adverse drug reaction?
  • Why are such a high percentage of these potentially lethal reactions preventable?
  • What can be done now to prevent these reactions?

Why are the elderly 4 times more likely to experience an adverse drug reaction?

Elderly patients are generally on a plethora of medications to treat any number of diseases and conditions, or for preventative reasons. Remembering every medication and the purpose for every pill that is taken is difficult, especially if they don’t bring all their bottles with them. Elderly patients simply are on more medications, thus putting them at greater risk to ADRs from both routine doctor visits and emergency visits to the hospital.

Why are such a high percentage of these potentially lethal reactions preventable?

Most of these reactions can be prevented if the provider issuing the prescription has the patient’s complete medication history. Providers with access to correct information stand to lower the rate of ADRs as they are armed with a more complete, current, and accurate picture of what medications the patient is on, thereby avoiding adverse drug events. In addition, some of the interactions can be serious but not commonly-enough seen for physicians to recognize without the help of decision-support software as would be found in e-prescribing software.

What can be done now to prevent unnecessary death and injury?

According to AHRQ, “Medication reconciliation refers to the process of avoiding inadvertent inconsistencies across transitions in care by reviewing the patient’s complete medication regimen at the time of admission/transfer/discharge and comparing it with the regimen being considered for the new setting of care.”
Utilizing an electronic prescription system that includes medication history or an electronic medication reconciliation system like the one provided by DrFirst and MEDITECH provides caregivers in the inpatient and outpatient setting the information they need to prescribe the correct medication without putting the patient’s life at risk. Some systems, like Rcopia, even allow providers to print a wallet sized copy of a patient’s medication history to carry with them in case of an emergency, or to give to physicians who are not using an e-prescribing or Med Rec system.

About pkaufman

Schooled at MIT, Dr. Kaufman nurtured a strong interest in medical informatics while a Bowman Gray School of Medicine faculty member. After entering private practice he founded PiNK software in 1996 to produce EMR software, later becoming DrFirst’s chief medical officer upon its founding. He lectures nationally on various healthcare IT topics, and as a board certified gastroenterologist, he continues a limited clinical practice. Dr. Kaufman is a member of the Health IT Standards Committee, Privacy and Security Workgroup for ONC (Office of the National Coordinator for Healthcare Information Technology). Representing the American Gastroenterology Association’s (AGA), Dr. Kaufman is a delegate to the AMA and was the co-chair of the Physicians Electronic Health Record Consortium (PEHRC). He has participated on workgroups at CCHIT (stand-alone e-prescribing), HIMSS (e-prescribing), and NCPDP (e-prescribing).