Large language model (LLM) agents can support medication review between clinical visits, but safe choices for older adults with multimorbidity depend on conditions, medications, and geriatric risks that users may omit. We introduce ATLAS, a coupled graph--policy distillation framework for patient-adaptive medication safety. ATLAS structures guideline evidence as a medication-safety graph. Targeted questions update the patient state and distill relevant relations into a patient-specific medication conflict graph (PMCG). A risk-first multi-agent policy uses the PMCG to screen contraindications, assess cautions and monitoring needs, identify safer alternatives, and verify the final medication plan. We also introduce GeriMedBench, an interactive benchmark that tests safety-critical information acquisition and evidence-based decision revision. Across a European non-interactive multimorbidity benchmark, an Asian interactive multimorbidity benchmark, and an Asian non-interactive cross-guideline benchmark, ATLAS achieves the strongest complete-decision performance among the compared systems. On the European non-interactive multimorbidity benchmark, it exceeds the strongest proprietary LLM baseline by 53.73 points in Strict Success Rate and 14.63 points in overall safety reasoning score (OSRS), with no unsafe recommendations under the automated evaluator. A blinded clinician evaluation gives ATLAS higher mean ratings across all five criteria and flags potentially unsafe recommendations in one ATLAS case and two Gemini cases.
Applying a valid medication-safety rule when its patient-specific conditions are not met can produce an incorrect decision. Existing medical evaluations largely use isolated and fixed scenarios. A model may therefore answer correctly by recalling a drug-risk association without showing that it used patient information to decide whether the rule applies. To address this gap, we introduce MedPIC-Bench, a benchmark of source-verifiable recommendations and expert-validated questions for patient-specific medication-safety reasoning. It combines guideline-following questions with paired counterfactual questions in which a controlled change in patient information changes whether a rule applies. The benchmark contains 467 questions annotated along six clinical and reasoning dimensions. Across 28 medical-specific, general, and proprietary LLMs, every model performs worse on counterfactual questions, with mean accuracy falling from 63.6\% to 45.1\%. Models perform well when an explicit patient attribute directly signals a familiar contraindication, but struggle when patient information must narrow or withdraw a safety warning. Model rationales often acknowledge the changed patient information, yet the final answers retain the previous safety judgment. This vulnerability persists among medical-specific LLMs, whose average CF performance trails that of general LLMs. MedPIC-Bench therefore makes conditional rule application measurable and highlights the limitations of static medication-safety accuracy for assessing patient-specific reliability.
Jeong-ah Kim, Muhammad Ashad Kabir, Daniel Terry +1cs.AI
Introduction: Medication errors (MEs) represent a significant threat to global healthcare systems, contributing to patient harm. Introducing artificial intelligence (AI) in rural healthcare enhances patient safety. The aim is to explore the applications and effectiveness of AI technologies in enhancing patient safety and reducing medication errors in rural health settings. Methods: A scoping review was conducted through a systematic literature search spanning 2012 to 2025 across multiple databases, including EBSCohost, Emcare (Ovid), MEDLINE, and the ProQuest Consumer Health Database. Twelve primary studies from nine different nations were examined. Data were analysed thematically to obtain insights on AI interventions across the medication process. Results: AI technologies have been integrated into every stage of medication management, right from prescribing and dispensing to administration and post-administration monitoring. Four key themes came to light: (1) the various types of AI being utilised (like Clinical Decision Support Systems, Machine Learning, Natural Language Processing, and smart pumps); (2) the phases of the medication process that are affected; (3) how effective these technologies are in minimising errors and boosting workflow safety; and (4) rural-specific challenges including infrastructure, staff training, system integration, and alert fatigue. Several studies have demonstrated that machine learning-based surveillance improves incident detection and reduces prescribing and transcription errors by an impressive 34% to 80%. Barriers included lack of governance frameworks, financial limitations, and clinician resistance, which still present major obstacles. Conclusion: In rural healthcare, AI technologies hold great potential for enhancing pharmaceutical safety. They can allow data-driven monitoring, automate processes, and offer clinical decision assistance.