Researchers and patient safety  advocates have suggested certain measures to reduce the risk of  medication errors, and VA and DOD have incorporated many of these  measures as features of their health care systems. Inpatient medications are ordered  using the host facility’s formulary guidelines and filled through the  inpatient pharmacy. Shared Patients Experience Gaps in Medication Safety Measures

VA’s and DOD’s separate, uncoordinated information and formulary  systems result in gaps in medication safeguards for shared inpatients and  outpatients. VA and DOD providers and pharmacists have  ready access to health records of their own beneficiaries, largely through  CPRS and CHCS, respectively. Thus, these patients are subjected to the risks associated with  handwritten prescriptions, such as illegible orders and transcription  errors. All joint venture sites have taken steps to increase access to patient  information. For instance, pharmacies at  two sites stock drugs commonly prescribed for the other agency’s  patients, but neither host agency’s P&T committee has representatives  from both agencies. Recommendations For Executive Action

To better protect shared patients at the joint ventures, we recommend that  the Secretary of Veterans Affairs direct the Under Secretary for Health and  that the Secretary of Defense direct the Assistant Secretary of Defense for  Health Affairs to    develop the capability for VA and DOD providers to access patient medical  information relevant to medication decision making, regardless of whether  that information resides in VA’s or DOD’s information system and provide  training to physicians and pharmacists who need to use this access;    develop the capability to perform a comprehensive, automatic drug  interaction check that uses medication information from all VA and DOD  facilities and mail order operations and DOD’s network pharmacies, and  evaluate the potential for DOD’s PDTS to be used for this purpose;  require providers to use computerized order entry of medications for  shared patients where it is available and implement system modifications  that will enable providers to electronically order medications to be  dispensed at the other agency’s pharmacies; and    establish a joint VA and DOD pharmacy and therapeutics committee, or  similar working group, at each joint venture site to determine how best to  safely meet the medication needs of VA and DOD shared patients and to  overcome obstacles associated with separate formularies.
What GAO Found

Medication errors and adverse drug reactions are a significant concern for the Department of Veterans Affairs (VA) and the Department of Defense (DOD) because their large beneficiary populations receive many prescriptions. Each agency has taken steps to reduce the risk of medication errors, such as making patients' medical records more accessible to providers and performing checks for drug interactions. Although each agency has designed safeguards to protect its own patients, some VA and DOD patients receive medication from both agencies. Shared patients face a higher risk of medication error. Joint (DOD and VA) venture sites with inpatient facilities provide services to shared inpatients in the same manner as they do for their own beneficiaries; that is, medications are ordered using the facility's guidelines and filled through the inpatient pharmacy at that facility. Gaps in safeguards result primarily from VA's and DOD's separate, uncoordinated information and formulary systems. Joint venture sites have tried to address some of these safety gaps. For instance, all sites have made patient information more accessible by providing additional, although incomplete, access to the other agency's patient information system.