Vial of Life Project

A Division of the Bridge Building Foundation

a 501 (c) 3 Public Charity

Published in the Wall Street Journal Tuesday, May 23, 2006


What Drugs Do You Take? Hospitals Seek To Collect Better Data and Prevent Orders

In the movie, "Something’s Gotta Give," Jack Nicholson plays an aging Lothario, rushed to the emergency room after a heart attack, who won’t admit to taking Viagra in front of his young girlfriend. But then he yanks his IV tube out in a panic when the doctor warns of a potentially dangerous interaction between the erectile dysfunction between the erectile dysfunction of the drug and the nitroglycerin drip he just started.

The scene gets big laughs, but there's nothing funny about the danger when hospitals have inaccurate or incomplete information about a patient's medications. With drug errors responsible for killing more than 7,000 hospitalized patients a year, new national patient-safety standards, which went into effect in January, require hospitals to have formal processes known as "medication reconciliation." This means hospitals must have a set routine for collecting complete drug and allergy histories and comparing them with new medications that doctor's order. The aim is to avoid problems both while patients are in the hospital and when they are discharged with new drug regimens.

As part of their programs, hospitals are stepping up efforts to educate patients and families about the importance of maintaining their own up-to-date medication and allergy lists—and taking steps to make them easily accessible in case of an emergency. "We can’t be completely effective if we don't have all the medication information, and it's going to take more patient involvement," says Sandra Sheppard, head of accreditation and regulatory compliance at Wilkes Regional Medical Center in North Wilkesboro, N.C., one of 37 hospitals working with VHA Inc., a national alliance of nonprofit hospitals, to put standardized medication reconciliation systems in place.

Eventually, hospitals hope to store medical histories online and offer portable electronic personal health records on a "smart card" or secure Web site. But for now most hospitals aren't wired for such technology, and are turning instead to more low-tech, paper based solutions such as wallet-sized cards that can be pre-printed or downloaded from their Web sites.

Wilkes and other hospitals, including Stanford University's hospital, are participating with emergency-response organizations in one program known as Vial of Life (, which offers medication forms that patients can fold up and store in an empty vial or pill bottle in the refrigerator, alone with a bright red sticker for the door to alert emergency responders such as paramedics or firefighters. Ms. Sheppard, whose staff distributes the vials through pharmacies, churches and health fairs, says, "A lot of people pick up three or four at a time and being them home to Mom and Dad."

The Arizona Hospital of Healthcare Association offers one medication list form at; another, called the Universal Medication Form, is available online from groups including the South Carolina Hospital Association ( The Joint Commission on Accreditation of Health Care Organizations, which set the new medication-reconciliation standards, also offers a form for consumers on its Web site (

According to the nonprofit Institute for Healthcare Improvement, which is helping thousands of hospitals develop patient-safety programs, poor communication as patients move through the hospital is responsible for as many as 50% of all medication errors and up to 20% of adverse drug events. By developing rigorous medication-reconciliation systems, through, such errors can be cut by 75% to 80%. Among them: inadvertently omitting a medication a patient was taking home during a hospital stay; failing to ensure that home medications temporarily stopped during a hospital stay are restarted when the patients is transferred or discharged; duplicating medication orders either because the patients may already be taking the drug because of confusion between brand and generic versions of a drug; and prescribing incorrect dosages.

James Lederer, medical director for clinical improvements at Forsyth Medical Center in Winston-Salem, N.C., a unit of Novant Health, says before participating in the VHA program starting last June, medications at nine Novant hospitals in the state were adequately reconciled online 20% to 30% of the time. That rate has since increased to 80% to 95%. Those at greatest risk are geriatric patients, "who may have five different doctors and take 15 different medicines," Dr. Lederer says. Some may not remember all the drugs they are taking, or get confused about drug names, or neglect to mention herbal supplements vitamins, over-the-counter medications and things like topical patches. While it is up to hospitals to put rigorous systems in the place to make sure there are no mix-ups after admission, "it does put the onus on the patient" to provide a complete list of medications, and to make sure a patient or family member reviews any changes to the drug regimen at discharge, he says.

Kathy Traylor, director of quality support services at Centra Health, Lynchburg, Va., which operates two hospitals, saw the problem in one of them firsthand when her grandmother was discharged after hip surgery, without anyone ordering her regular diuretic to be started. That led to 20 pounds of fluid build-up and painful swelling in her legs, and forced her to put off starting physical therapy for two weeks. Since starting work with VHA on the medication-reconciliation program last June, Centra has cut its unreconciled-medication rate by 75%, and partnered with local doctors, nurses and nursing homes to help patients create medication lists. It is now working on a method for linking local doctors' medication records to the hospital's system electronically.