Communication via EMR can improve notification about discontinued medications
Communicating via electronic medical records to notify pharmacies of discontinued medications may reduce potential safety events and costs, a speaker reported.
According to a poster presented at the virtual American College of Cardiology Quality Summit, researchers at Intermountain Healthcare tested several fixes with the aim of improving communication between clinicians and pharmacy staff with regard to discontinued medications and changes in dosing.
According to the presentation, although discontinued medications are updated in the EMR system and signed by the physician, there is not currently a system to notify the pharmacy of this information. Researchers posited that this lack of communication regarding discontinued medications or incorrect doses may lead to confusion for the patient and put them at risk for safety events.
“Currently, there is no ideal way to notify a pharmacy that a clinician has discontinued medication for a patient, often leading to a discontinued medication or incorrect dose to be refilled and causing confusion for the patient,” Jeffrey A. Goss, FNP-c, MSN, the APP director of heart failure and family nurse practitioner at Intermountain Healthcare, said in a press release. “Patients are at risk for taking a medication that is no longer indicated or at the wrong dose, which has important medication safety indications.”
To address those issues, researchers tested several methods of improving communication about discontinued medications.
The first attempt involved nurses and/or pharmacists personally contacting the pharmacy via telephone to communicate any changes and request a medication be removed from the patient’s profile.
For their second attempt, researchers asked health care professionals to note medication change details in the “comments” box of a prescription before sending it to the pharmacy staff. According to the presentation, not all pharmacies notice this information and researchers determined it is not a reliable method of communication.
Lastly, the researchers turned to the CancelRX functionality in their EMR system, a feature specifically designed to notify pharmacies of discontinued medications. According to the presentation, this particular functionality was turned off due to a high number of error messages to clinicians’ inboxes. Moreover, CancelRX only works if the pharmacy staff are using it as well.
“Pharmacies often don’t know about this functionality,” Goss said during the presentation. “It takes a lot of personnel to track this and oftentimes the providers who are writing prescriptions are receiving error messages back into their electronic medical record when the pharmacy can’t receive them, which caused some frustration.”
For a period of 60 days, 16 providers on the Intermountain Medical Center advanced heart failure/transplant team activated their CancelRX functionality. During that time, researchers tracked 558 discontinued medications, corresponding to 359 error messages (64%) and subsequently 148 phone calls made to pharmacies.
“We documented what we considered was a potential for safety events,” Goss said. “The way we determined that was if a patient were to inadvertently take the new medication and the old medication simultaneously, would that be detrimental to the patient? If the answer was yes, we marked that down as a potential safety event.”
According to the presentation, 196 potential safety events were avoided with the use of both phone calls and CancelRX during the trial.
Pharmacies or chains that activated their CancelRX functionality and sent the most error messages to the trial team were Intermountain Pharmacies (n = 210), Smiths (n = 117), Walgreens (n = 38), Costco (n = 25), CVS (n = 23) and Walmart (n = 20).
“Increased communication between providers and pharmacies can be enhanced so that medication errors can be lessened,” Goss said during the presentation. “Ultimately, if this is turned on, the pharmacy and the health system end can communicate with one another, and it works seamlessly. Over time, there would be less need to track and communicate these medication cancelations. If medications aren’t being automatically dispensed, that would be a cost savings to the pharmacy, the patient and the insurance company.
“Overall, the implications of not having medications discontinued ultimately goes back to patient safety and avoidance of safety events,” Goss said. “We know that medication errors are on the rise and have consistently been a concern for all health systems. Our recommendations are that if your institution has this capability within its electronic medical record, that you work with your local pharmacy to also turn this on and work at integrating how this may look in your system and what potential benefits it may have to our patients in ensuring they receive proper medication at the proper time.”
Reference:
- Notifying Pharmacies of Discontinued Prescriptions Helps Reduce Safety Events. https://www.acc.org/about-acc/press-releases/2021/09/29/12/51/notifying-pharmacies-of-discontinued-prescriptions-helps-reduce-safety-events. Published Sept. 29, 2021. Accessed Sept. 29, 2021.
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Goss JA. Poster Session. Presented at: American College of Cardiology Quality Summit; Sept. 29-Oct. 1, 2021; (virtual meeting).
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