Risk Factor Controls in Patient Medication Management

In the quest for providing better outcomes and increased patient safety, it is critical to institute key controls in hospital care delivery processes. Across departments, these controls can help provide a significant reduction in indemnity losses, a reduction in claims management costs, improved value-based reimbursement performance, and optimized reserve capital allocation. In this blog series, we will look at some sample risk scenarios and how controls play a role in outcomes. To visit EisnerAmper’s Controls Library, click here.

Dispensing medication can be just as much of a risk when an outpatient surgery takes place as it is during an intensive hospital stay. Managing patient medication is a key component of care post-surgery, and outpatient procedures can increase the risk of a mistake occurring upon discharge. 

Let’s take the case of a scheduled outpatient surgery where a patient is at the hospital for an arthroscopic knee intervention. The plan is for the patient to go home right after the procedure, which can add additional pressure on the surgeon and their staff to not just successfully handle the surgery, but also record and calibrate all new meds with existing prescriptions.

When the patient came to the hospital prior to admission, their existing medications were documented and verified prior to arrival through medication reconciliation. The next step in the process would involve the surgeon’s staff completing discharge medication reconciliation post-surgery. This step may happen in the surgical theatre while a resident closes the incision (at teaching hospitals) or occur in between cases. The circumstances vary depending upon the institution and patient condition. At this point, the surgeon would prescribe discharge medications, which may include pain medication.

If the medication reconciliation is not done properly, with existing conditions and treatments considered, the patient could potentially go home with the wrong meds or poor instructions for managing the right ones. Pre-existing conditions are a critical consideration. In this scenario, our patient happens to be taking regularly prescribed medication (leflunomide) for rheumatoid arthritis. That drug would interact poorly with the post-surgery medication regimen, hampering the patient’s recovery. So, with a proper medical reconciliation complete, the surgeon will have the patient stop taking leflunomide for a time while they recover.

Once the surgeon has completed their post-operative medication reconciliation, then the post-anesthesia care unit step-down nurse will interact with the patient. They begin the discharge process by printing the after-visit summary (“AVS”), detailing procedure follow-ups, home care instructions and the medication regimen. These controls are set up in a hospital’s system, pre-programmed to either prevent the AVS from being printed or create warnings if the medication reconciliation process is incomplete. Once activated, the warning includes a monitoring component to confirm retrospectively that the ambulatory surgery area is compliant when it comes to verifying completed medication reconciliations. This feature may help identify problem clinicians who are not following the process completely.

With AVS in hand, the nurse can go through discharge instructions with the patient and their caregiver as they prepare to depart. With proper “medrec” controls in place, our patient’s leflunomide prescription is identified, their post-surgery regimen is adjusted to reflect the condition, and their discharge documents include a clear order to stop maintenance drugs until the patient can be reevaluated after recovery from the procedure. With a more informed course charted for a safe healing and rehabilitation process, our patient is on the path to recovery with a new knee.

Click here to learn more about how controls can impact patient safety across different departments.