Vermont Health Clinics Promote AHRQ’s Medication Safety Guide

A Vermont-based based trio of Federally Qualified Health Centers (FQHC) has improved medication use and safety for approximately 8,000 patients by adapting an evidence-based strategy from AHRQ's Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families.

Little Rivers Health Care now reminds patients 48 hours before their appointment to bring in all their medications – prescription and over-the-counter (OTC) – to ensure that they're current, accurate, and safe. The FQHC provides a wide range of primary care services, including family medicine, pediatrics, obstetrics, behavioral health, oral and dental health, and outpatient procedures.

Creating a safe medication list that involves both health providers and patients is considered the "first line of defense against medication errors," according to the AHRQ guide. Clinical staff at Little Rivers' Bradford, VT, site tested the safe medication list for 3 months in practice while serving as a field test site for the AHRQ guide.

Maureen B. Boardman, M.S.N., A.R.N.P., recruited a group of patients at the Bradford clinic to bring their medications to clinic appointments in a brown bag and take part in discussions about safe medication practices. She is the clinical research director at the Dartmouth University Geisel School of Medicine  Primary Care Practice-Based Research Network, which includes Little Rivers Health Care.

During the discussions, patients' perceptions of safe medication practices raised some concerns, Boardman said.  For example, there were "several instances where patients didn't realize a medication had dropped off the list, and they didn't realize they were continuing to take it [by mistake]," she said. Patients also acknowledged taking herbal supplements but didn't think they were important enough to mention, she added.

Such oversights and lapses in communication are not unusual. Medication errors are common patient safety incidents in primary care, with rates ranging between 1 and 90 of every 100 prescriptions, according to scientific data cited in the AHRQ guide. Medication safety issues include prescribing errors, contraindications, over- and under-prescribing, and patient adherence.

Learning that patients didn't fully understand which medications they should be taking or understand the potential risks of adding supplements and vitamins "burst our bubble a little bit," Boardman said.  "We thought that we were doing a pretty good job, but not as good as we thought we were."

As a result of the 3-month field test interviews, Little Rivers Health Care implemented the new previsit medication reminder phone call process at its three clinics, Boardman said.

Boardman noted that having all patients' medications available at the visit allows clinical staff to verify that patients are taking the right medications, learn whether they're taking them correctly, and find out if they're taking supplements or vitamins that may interact with medications.

The extra attention to medication safety is well worth the effort, Boardman reports. Besides, she said, on the whole, engaging patients in conversations about how to take their medications safely doesn't involve an additional time investment.

"Most of the time, patients want to know: is it safe, how do I take it, and what are the potential downsides of taking it," Boardman said.