Tools for Optimizing Medication Safety (TOP-MEDS)

The US healthcare system has ongoing problems of underuse, overuse, and misuse of medications, leading to medication errors, adverse events, and less-than-optimal patient outcomes. For instance, medications with high risks, such as opioids, are frequently selected and dosed improperly; confusion around the names of medications may cause patients to receive the wrong drugs; and patient information regarding medications is generally poorly designed and confusing, leading to unsafe use by consumers.

To address these issues, AHRQ funded this patient safety Centers for Education and Research on Therapeutics (CERTs) project at Northwestern University focused on developing tools for safer medication use, called the Tools for Optimizing Medication Safety (TOP-MEDS). The CERTs demonstration program is a national initiative to conduct research and provide education that advances the optimal use of therapeutics including drugs, medical devices, and biological products. The TOP-MEDs CERT was funded to conduct numerous projects in four areas: statistical methods for studies of drug safety and effectiveness, opioid prescribing for acute pain, preventing and detecting drug name confusions, and patient-centered drug information.

The specific aims of the project were to:

• Develop and apply a multivariate person-time logistic regression model for large-scale adverse drug event (ADE) screening. 
• Improve the safety and effectiveness of inpatient acute pain care by developing and validating a web-based simulator to train prescribers in the proper selection and dosing of opioids. 
• Refine a standard battery of tests for pre-market safety screening of drug names, and develop and test methods for preventing and detecting drug name confusion errors in clinical databases. 
• Rigorously evaluate an electronic health record (EHR)-based, low literacy strategy for promoting safe, effective prescription drug use among English- and Spanish-speaking patients in an urban primary care setting. 

A variety of methods were used across the projects, including statistical analysis of claims data sets, retrospective review of EHRs, simulation studies, prospective and retrospective observational studies, randomized trials, and psychological experiments. The team reported success in the first project area, working toward creating a model for ADE screening for broader adoption and dissemination. At the end of the grant funding period, the opioid simulator had been developed and tested. In the initial analysis, it was shown to be effective as a teaching tool. In addition, early analysis for the health literacy trial suggested that there may be a small or null benefit to the patient.

The research team has been active in disseminating their findings through publications and presentations. In addition to the project's final report that includes associated publications, additional information on the progress of TOP-MEDs may be found via the National Patient Safety Foundation.