much easier to compare results from different sepsis studies and to better understand the various syndromes.


The public at large needs to develop a healthy respect for the risks as well as the benefits of medications. For example, one study revealed that patient-level errors are associated with about 20 percent of ADEs in the ambulatory setting among the elderly (Gurwitz et al., 2003). Engaging the patient as an active participant in decisions about and monitoring of medication use is critically important. Thus the committee recommends pursuit of a research agenda aimed at delineating effective strategies for involving patients and their families in the prevention, early detection, and mitigation of harm due to medication errors (IOM, 2004), with particular focus on the following topics:

  • Determining how best to present information to patients to facilitate their understanding of medication use and safety, including the development of a consumer-friendly nomenclature for representing this information.

  • Developing improved systems for supporting patients in identifying and eliminating barriers to following the prescribed medication regimen, or in seeking advice before altering the regimen in response to drug side effects or barriers to administration.

  • Developing improved systems for supporting surrogates’ roles in safe medication use when patients are receiving medications from professionals and are unable (too ill, disabled, or cognitively impaired) to monitor the administration of or their response to the drugs.

  • Developing standard approaches to the maintenance of personal medication lists and investigating the effects of these lists on the effectiveness of safety strategies, such as medication reconciliation.

  • Developing strategies to inform ambulatory patients of clinically significant abnormal test results, including the use of computerized patient notification of such results.

  • Exploring the effectiveness of patient self-monitoring devices, such as home finger-stick devices and nomograms to self-adjust wafarin dosages.

The committee believes medication self-management can be enhanced with tools available through personal health records. In this regard, CMS, the FDA, and the NLM should collaborate to confirm a minimum dataset for personal health records and develop requirements for vendor self-certification of compliance. Vendors should take the initiative to improve the use and functionality of consumer-oriented information tech-

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