April 21, 2011

New e-tool helps monitor patients’ home medications

New e-tool helps monitor patients’ home medications

As part of ongoing efforts to improve medication safety, Vanderbilt University Medical Center recently rolled out a major upgrade to the electronic tool used for gathering each patient's home medication list at hospital admission.

Medication reconciliation is the technical term for verifying, appraising and updating a patient's medication regimen. During hospitalization and over the course of multiple visits to multiple outpatient providers, careful reconciliation of a patient's medication list by each successive provider helps prevent problems such as unwanted drug-drug interactions.

When providers share a reconciled list with the patient and the next provider down the line, care becomes safer and more efficient, but this is one standard of care that hospitals and clinics throughout the country struggle to meet.

There's an obvious role for clinical information technology in supporting this documentation and communication. In applying innovative IT solutions to this problem, Vanderbilt may help lead the country to improved medication reconciliation.

The new tool is called PAML2, for preadmission medication list, version 2. The tool's user interface is greatly improved in this version, say the developers.

“We've developed and tested a tool that is much more clear and intuitive than the previous tool. My hope is that this new version will make it easier for providers to collect and create a good preadmission medication list,” said Neal Patel, M.D., MPH, chief medical informatics officer for inpatient areas.

“The goal is a home medication list in electronic form that's recognized by everyone as dependable. PAML2 will set the stage for more dependably integrating consideration of the home list into day-to-day clinical decision-making across our hospitals. It will also better support our discharge process,” Patel said.

Once PAML2 wins over users, the plan is to integrate it with certain other tools that aid the writing of the admission history and physical, the writing of patient instructions at discharge, and the writing of letters to referring providers at discharge.

Using PAML2 is similar to using an electronic shopping cart on Amazon.com, says Quality Consultant Jay Morrison, M.S.N., R.N. A pharmacy database running in the background steers the user to select from standardized drug names.

Like its predecessor, PAML2 also allows the user to pull in standardized drug names from the patient summary section of the Vanderbilt electronic medical record and from the hospital current orders list. A new “help” menu offers pointers on how to collect an accurate list from the patient and family.

“If we get a good list up front, we better our chances down the road for putting useful information in the hands of prescribers,” Morrison said.
PAML2 was piloted by adult Cardiology and by Pediatric Acute Care.

For a week after PAML2 is turned on, trainers from Systems Support Services will spread through VUMC hospitals to answer users' questions.
Patient care managers have also been given a brief PAML2 user's guide for distribution as needed.