These rules serve as the basis for the discussion of medication safety and quality improvement in this report. Applying these rules, the committee developed a new vision of a patient-centered, integrated medication-use system. This model, outlined in Table II-1, is intended to engender new expectations and actions on the part of those involved at all levels of the system by conceptualizing important factors that influence the current and the envisioned, safe state. More in-depth discussion of specific actions that can be taken to achieve the safe state is presented in Chapters 4 through 8.

TABLE II-1 Transforming the Medication-Use System: Where We Are and Where We Want to Be

Reality: Where We Generally Are

Vision: Where We Want to Be

Patient and Community Experiences

The health system is provider-centric and provider-directed.

The health system is patient-centered; patients are listened to and respected as informed, engaged full partners and the source of control.

The patient experience is highly variable; minimum expectations are not consistently met.

Specific patient rights and expectations are honored across the health system and applied specifically and consistently to the medication-use process.

Providers focus on patient medications in the context of an encounter.

Patient health and satisfaction are the focus, optimized through self-care, self-management, and the continuum of care.

Self-management issues include nonadherence, knowledge deficits, practical barriers, and attitudinal barriers.

Through supportive interventions, education, patient contracts, and behavioral change, patients are skilled in managing wellness, along with their acute, chronic, and disability needs.

Families and caregivers are not generally recognized or supported.

Families and caregivers are encouraged to be full participants in care.

Patients, families, providers, and pharmacies lack a single accurate patient medication record.

Each patient has a single electronic medication record. The patient, all providers, and pharmacies work from this record. All medications are reconciled against this record.

Over-the-counter (OTC) drugs and dietary supplements are not considered medications for purposes of the medication record.

Medications, OTCs, and dietary supplements are part of the medication record and patient care.

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