med reconciliation in the ED - page 2

How does your facility handle med rec? Our way is so time consuming and it doesn't seem to make sense to me. Maybe I'm being a bit naive with this next statement but here goes....... I can't... Read More

  1. by   gonzo1
    Thank you for the clarification on my behalf luckylucy. As I stated in my second post it is obvious that a tech with advanced training such as a pharmacy tech WOULD BE QUALIFIED TO DO MED REC. However, the majority of CNAs working on any given hospital floor does not have the advanced training to do this. The point of my original post anyway was that even though we hate to do it med rec really is a nurse job as it gives us a chance to become familiar with the meds our patients are on and their level of understanding of each drug they are on.
  2. by   neneRN
    I don't have a problem filling them out, we've always had to list all pt meds on our triage sheets anyway. But this has just served as a guide for the ER docs to have an idea of what the pt is on, and also for us to know what kind of medical Hx the pt has. (you know, the pts who say their only Hx is HTN, but you can deduce from their meds that they actually have CHF, A-fib, whatever)

    I do have an issue however, with the pts who come in and know only some of their meds or know their med names but not the dosages. Sometimes EMS will bring in all the meds from the pt's home and the pt may only be taking half of those meds. Even though I am filling the form out to the best of my ability in these cases; the information is incomplete and my name is signed to it. We do not have the time in the ER to track down family members/pharmacies, etc. to get ALL the information- that's just not a priority. So, the pt gets upstairs and the floor nurse still has to revise my incomplete list, or maybe doesn't add anything to it because they assume its complete; there's potential for error. Or sometimes the admitting doc sees the pt in the ER and writes orders based off my incomplete list.

    I think the form is a good idea, but I'm not sure that the ER is the best place to initiate it.
  3. by   nuangel1
    i agree with neen.we do med rec on all ed pts .i can't believe how many people don't now what they are taking dose etc.i try as best i can to do it -i have called family members ,nursing homes and pharmacies but sometimes you can't get an accurate list .so i write pt unknown whether its drug name dose etc.i document who i have called in an attempt to complete it.but i actually had a nurse call and yell at me for not completing it on a 90 yr old demented pt form home -he didn't know wife did not know could not tell me pharmacy name hadn't seen pcp for longtime.the daughter who was not able to when she came for visit.when she got home she was goingto call nursing floor with doses etc .i documented the above nurse was still not satisfied .
  4. by   mmutk
    We are not on computerized charting in general, but we do do our med lists on computers. It is sooo cumbersom in my opionion I find myself sitting in front of a computer allot longer than I need to be, it takes away time for patient care...

    I am fighting it, but due to things like JCAHO and educators that don't live in the real world, I am losing that battle
  5. by   flipnenya
    Our ED has really clamped down on the med rec forms and the floor nurses will not accept med rec forms if they aren't completely filled out and signed. we all hate these forms but realize there is not much we can do about them due to JCAHO. A recent article by the ENA discusses how time consuming these are for ED nurses so we do have the ENA on our side.
  6. by   CrazyPremed
    Our ER just started using these forms, too. They are given to the patient, and they fill them out to the best of their ability. The only way to completely resolve this is - in my opinion - to hire pharmacy techs or nurses to 'med triage' while the pt is being triaged. There is absolutely no time for the average ER nurse to do this.

    In addition, as an ER tech/secretary, I think that most techs/aides do not have the training to fill these out. Many that I work with (secretaries included) do not even spell the Dx right or know what they mean. I am in a formal secretary program through a CC and we spend almost a month learning common medications and routes of administration, and MAR'ing. If hospitals provided this much formal training to the techs and secretaries - and forced us to pass an exam - then I think that this may be a START to solving the problem. But, as it stands now, only nurses/docs should touch the things.

    CrazyPremed
  7. by   pkapple
    We always ask patient for list of meds and dosages, last time taken and why taking f it doesn't seem to fit history given. On earaches, toothpain,?fx/lacs we don't pursue it very far. I do try to get better info on anybody being admitted or transferred. Not always very successful esp at 0400. I am pretty surer from reading the language of the giudeline that the purpose is to RECONCILE the list with adm orders and changes in level of care thru d/c, so the crappy list from tx/street folks really would never be reconciled anyway. I'm sure not going to get any help from a PCP or pharmacy at 0400 anyway. Guess it will have to be up to the floor to complete the reconciliation. We haven't implemented any special form yet, but hey our docs still write continue home meds or get med list from office!
  8. by   10MG-IV
    Quote from ERERER
    we just went through JCAHO, yuck. glad that's over....if for no other reason now admin might not have the excuse to delay things "until after joint"..

    anyway, seems as though JCAHO wants med reconciliation forms filled out on ALL ed patients, not just admissions as we had been doing. can you imagine filling out all that on someone who just wants an rx for an earache or a couple of stitches??? especially when we are so busy??????

    The ENA has addressed this with JCAHO and on their website is a copy of the letter that was sent, cosigned by the ED Docs groups, etc.

    they can't be serious, can they?????
    Yes because they are idiots that have never done real nursing, bedside,stretcher side, on the floor down and dirty real nursing. give an enema, shot, start an IV, hang a dopamine drip, put down a e-wall, salem sump, or any kind of tube for that matter nursing. they are paper pushers that are making the world a safer place one sheet of paper at a time. Some one give them a rope.
  9. by   MassED
    Quote from ern91
    How does your facility handle med rec? Our way is so time consuming and
    it doesn't seem to make sense to me. Maybe I'm being a bit naive with this next statement but here goes....... I can't believe JCHAO wants nurses to spend so much time on something like this. Maybe someone other than a nurse could do this? Pharmacy tech, Unit Secretary? I remember when this was the physician's responsibility. I work for a hospital with a very cumbersome computer documentation system (Meditech) and the ER version of this system is not nurse friendly.It takes a long time to do med rec on pt's with multiple meds, and the nsg home pt's lists are 3 and 4 pages long.
    I understand the importance of med rec, I just think pts would be better served if the nurse wasn't tied up with so much of their time spent on data entry.
    I work in an ER that uses Meditech (NOT ER specific, hello there are good ones out there for the ER that can communicate to Meditech! Hellllooo MEDHOST, anyone!) Meditech is archaeic and cumbersome, to say the least.
  10. by   MassED
    Quote from ERERER
    we just went through JCAHO, yuck. glad that's over....if for no other reason now admin might not have the excuse to delay things "until after joint"..

    anyway, seems as though JCAHO wants med reconciliation forms filled out on ALL ed patients, not just admissions as we had been doing. can you imagine filling out all that on someone who just wants an rx for an earache or a couple of stitches??? especially when we are so busy??????

    The ENA has addressed this with JCAHO and on their website is a copy of the letter that was sent, cosigned by the ED Docs groups, etc.

    they can't be serious, can they?????
    That is why having an ER computerized system, once the meds are entered on the patient and they come again (you know they will!), that information is pulled into the next record. You just have to check that the meds are the same, update the changes, the new pharmacy.... blah blah. It's pretty easy, as long as a nurse on the front end does their job.
  11. by   interleukin
    Simply, nurses should not be doing med recon.
    The day we can add, alter, and/or delete meds. is the day say we should be filling out these forms.

    We are being used at high-priced data entry clerks...period.

    The problem is not that JHACO mandated this. The problem is nursing's historic inability to ever say "no" to yet another indirect patient care tasks.

    That is what should have been the issue here, and that is what should have had the nurses screaming, "When is enough enough!!!!?"
  12. by   Christy1019
    like i've said in previous posts, my ER recently had JCHAO come in a few weeks ago, and luckily their main problem w/us was med reconciliation, and instead of leaving unknown doses blank, they wanted us to type in UNK.. whateverrrr... but now our nurse managers are coming up w/all these little "creative ideas" to fix our "issues" like having our float nurse when shes not busy to work on med reconciliations strictly, she still gets paid the same, but they get done, and she doesnt have to see patients at the same time. plus now to raise those damn press gainey scores we have the sweetest lil old guy that volunteers to give ppl blankets and pillows that we can't always run to the back to get, and he sits and talks w/ppl that are upset and u'd be amazed how many anxious patients he quieted down. now they wanna bring in a TON of these volunteers... most likely gonna be the older ones that tend to do the extra caring ppl need that sadly enough, us nurses cant always provide anymore! just a suggestion to ur boss, to have one set nurse work that day at her pay and do all the med reconciliations but not treat patients, and she doesn't have a med reconciliation to do she can see if the patients need anything? kill two birds w/one stone... i'd takek the job lol
  13. by   MassED
    Quote from Christy1019
    like i've said in previous posts, my ER recently had JCHAO come in a few weeks ago, and luckily their main problem w/us was med reconciliation, and instead of leaving unknown doses blank, they wanted us to type in UNK.. whateverrrr... but now our nurse managers are coming up w/all these little "creative ideas" to fix our "issues" like having our float nurse when shes not busy to work on med reconciliations strictly, she still gets paid the same, but they get done, and she doesnt have to see patients at the same time. plus now to raise those damn press gainey scores we have the sweetest lil old guy that volunteers to give ppl blankets and pillows that we can't always run to the back to get, and he sits and talks w/ppl that are upset and u'd be amazed how many anxious patients he quieted down. now they wanna bring in a TON of these volunteers... most likely gonna be the older ones that tend to do the extra caring ppl need that sadly enough, us nurses cant always provide anymore! just a suggestion to ur boss, to have one set nurse work that day at her pay and do all the med reconciliations but not treat patients, and she doesn't have a med reconciliation to do she can see if the patients need anything? kill two birds w/one stone... i'd takek the job lol
    we had one of those guys, he was a younger guy, that would be out in the lobby to diffuse upset or angry people. He would offer drinks, blankets, etc. A patient care representative. It's a good idea.

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