Open-ended questions improve accuracy of patient medication lists
Electronic medical records may not tell doctors what drugs their patients are actually taking, leading to a potentially risky situation for adverse drug events. But asking open-ended questions at the start of a patient history can improve the accuracy of medication lists, researchers report in the Journal of Patient Safety.
“Knowing what medications a patient is taking, and having an accurate list of those medications reflected in their medical record, is a crucial first step towards preventing medication errors and adverse drug events,” says Dr. John Hickner, professor and head of family medicine at the University of Illinois at Chicago College of Medicine, the lead author of the study.
“Without really knowing what a patient is taking, or if we have an old, out-of-date list of medications — the risk for prescribing a new medication that may interact with something a patient is taking, or giving the patient a drug that does the same thing as something else they are taking, or even worse — those possibilities become more likely.”
“Medication reconciliation” can involve interviewing patients about their meds, having patients bring their meds to office visits, reviewing medication lists, and more. Good medication reconciliation has been linked to fewer medication errors in inpatient hospital settings, but little research has been done in outpatient settings.
Hickner and his coworkers observed 231 patient visits at Cleveland Clinic primary care practices and noted any behaviors or actions of patients, physicians or medical assistants that could affect the accuracy of medication reconciliation.
“Our intent was to identify any factors that were associated with accurate medication lists as a starting point for developing best practices,” Hickner said.
Patients were interviewed within two weeks of their visit to see if the medications and doses they were taking matched the electronic medication record.
The researchers noted that when medical assistants began discussions with open-ended questions — such as “Tell me about your medications,” rather than yes-or-no questions, like “Are you still taking this medication?” — agreement with the medication list in the medical record was three times more likely. Fifteen percent of patients had perfect agreement between the prescription and nonprescription drugs listed on their electronic medical records and what they reported taking, and 31 percent matched for their prescription medications only. On the other hand, 39 percent had four or more discrepancies.
Forty-two percent of the medications that patients reported taking did not match what was listed on their medical records, with omission being the most frequent error. Among those discrepancies, about half had minimal potential for harm, 30 percent had potential for minor harm, and 21 percent had potential for serious harm.
“Open-ended questions lead to better communication with patients, and we suggest, based on this study, that physicians, nurses and medical assistants use these kinds of questions to start the medication reconciliation discussion to improve list accuracy and ultimately, patient safety,” Hickner said.
Dr. Alexis Reedy, Jun Yun Yeh, and Amy S. Nowacki of the Cleveland Clinic are co-authors of the paper.