med reconciliation in the ED

  1. 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.
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  2. 30 Comments

  3. by   CaseManager1947
    Our hospital is not online with computer charting yet, we go live here in a month or so. Right now, we have a Med Rec form that has spaces for about 20 meds, whether the doc wants them continued, dc'd, or the dose modified. At the top is a place for allergies of all kinds, rx, latex, foods, etc.
    The nurse gets the orders from the physician to continue/hold/ or modify whatever meds he wants, and yes that includes going thru a 3-4 page NH MAR. Sorry, JCAHO is firm on this one, it is not going to go away. And weren't we doing this anyway, without a formalized method to document it??? At least I hope we were doing it. I've called family members, pharmacies, nursing homes ( if they forget their 3 page MAR in the transfer papers), whatever is needed to get those current meds. That form then with the meds is taken as a phone order and faxed to pharmacy to get your admit meds. Doc has to co-sign his phone order within 24 hrs, just like any other telephone order. I don't see unit secretaries doing that... too much clinical info for them. I guess we're gonna have to bite the bullet on this one.
  4. by   gonzo1
    I hear you and feel your pain. But unfortunately it is here to stay. Although I hate to admit it, it does kind of make sense because we should know from the first nurse till the last nurse at discharge what meds the patient is on. Only a nurse can do this because a tech or secretary would not be able to spell the meds right, or know if a patient is taking meds that are not compatible.
    The other day a tech was doing triage for a short time and the pt told the tech the one med they were taking. The tech spelled it "delodded" dilauded. Took me a couple of minutes to figure that one out.
    Have had a lot of patients say stuff like "I'm on a blood pressure med, you know the one with the long name, hydro something or other" I can suggest hydrochlorothiazide. This jogs their memory and a tech wouldn't be able to do this.
  5. by   Altra
    We must enter known meds in order to complete admission documentation for admitted patients, so I have to enter these in some time before faxing report to the floor or signing out the documentation. Complete, accurate readable MARs from an LTC or other facility are wonderful, so are those grocery bags full of meds when the meds are in the original Rx bottles ... otherwise I make an effort to get info from the patient/ family but a fair number of times I just put in the med with dosage unknown. If they don't know it, they don't know it. We do not call pharmacies or PCPs to obtain this info.

    Someone mentioned the reason that techs/clerks shouldn't be responsible for this because they may not have the clinical knowledge to know if meds are incompatible, etc. Just my 2 cents -- I can notice that a patient's med regimen is inconsistent/incompatible/whatever, but that's not something that's going to get "fixed" in the ER.
  6. by   luckylucyrn
    We also have a cumbersome list in our ED, and our management decided that we could give the list to the patients in Triage and have THEM fill it out. While it saves time (and I am grateful for that), I don't think it's a good idea for patients to fill it out. Lots of misspellings, inappropriate doses, etc. Then its a question of whether anyone actually goes over the list with them later.
  7. by   JessicRN
    Quote from luckylucyrn
    We also have a cumbersome list in our ED, and our management decided that we could give the list to the patients in Triage and have THEM fill it out. While it saves time (and I am grateful for that), I don't think it's a good idea for patients to fill it out. Lots of misspellings, inappropriate doses, etc. Then its a question of whether anyone actually goes over the list with them later.


    ackkk don't know what most of your pt are like but right now our patients have to write there name address and date of birth on a sheet of paper. more then half have to have the triage nurse stand beside them and tell them how to do it There is a running joke here that "there is no intelligent people in Cambridge (remember I said intelligent not educated)(the instruction are written in 5 languages on the wall) I can barely make out the name when they are done. How the heck could you hand them a med reconcilliation sheet and get them to do it. Also nurses have a tough enough time getting them right and you expect someone with little to no education to do this? heck 80?% of the time the patient answers with " my doctor knows or its in my chart. or its at home " when asked what meds they are taking.:chuckle
  8. by   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?????
  9. by   luckylucyrn
    Yep, we do that in our ED all the time....Med reconciliation on EVERYONE. Even the earaches, the sore throats, etc. It stinks, but now it's just part of my routine.
  10. by   Nurse_Diane
    Quote from gonzo1
    I Only a nurse can do this because a tech or secretary would not be able to spell the meds right, or know if a patient is taking meds that are not compatible. The other day a tech was doing triage for a short time and the pt told the tech the one med they were taking. The tech spelled it "delodded" dilauded. Took me a couple of minutes to figure that one out.
    Have had a lot of patients say stuff like "I'm on a blood pressure med, you know the one with the long name, hydro something or other" I can suggest hydrochlorothiazide. This jogs their memory and a tech wouldn't be able to do this.

    I have to totally disagree with your post. I am a pharmacy tech as well as a nursing student. My job as a pharmacy tech at my hospital is DOING med recs for the nursing staff in the ER.

    Trust me, even though "I'm just a tech" I can spell, and I do in fact know that "hydro something" means HCTZ......... I'm offended that you think pharmacy techs like myself can't do this type of job!
  11. by   glasgow3
    Our ER rarely if ever does the Med recon forms. lolol And we have Joint Commision due any time now. lolol Can't wait, give the suits something to do----such as write plans of correction.

    Nursing home patients are usually the least of my worries. At least there is a single, comprehensive list for those patients. They might not have brought it, but at least such a list exists.

    But what gets me is the patients who haven't a clue about what they are taking. You know----the very same patients who are rating the nursing care they receive on their Press-Ganeys.:uhoh21: Just where is the individual responsibility for bringing a list or knowing the medications they are taking at at what dose/frequency? Ohhhhhhhhh...that would be asking too much...waaaaaaaayyy too much waaaaayyyy too complex to understand. Yet when they have a complaint, everything these "wise consumers" of health care say is taken at face value.

    But no matter I have plenty of time to contact every pharmacy, every clinic, every doc etc in town to find out what they're taking. After all I'm a nurse and any number of tasks assigned can be fit into the same time frame.
  12. by   gonzo1
    DianeRNstudent, You obviously have medication experience working in the pharmacy, but not every tech has that experience. It is nice that you have the pharmacy experience as it will help a lot in nursing school.
    As for the med rec forms the only way to insure consistent information is to leave this job, no matter how aggravating to either an RN (which you soon will be) or an MD. Hope this clarifies what I meant at least a little.
  13. by   AggieQT
    I am also a CPHT while waiting to get into nursing school ... And it is my job to figure out what meds pts are on.... Pts come in all the time wanting meds refilled and they use descriptions like "that white pill" or "i don't know, its birth control" or "its for my toes, something for fungus" or "its for my diabetes" I've only been a tech for two years but I can easily suggest names AND spell them correctly. I know that it is the RNs job to chart everything for liability purposes and I can understand why, but I think you should reevaluate your ideas on Pharmacy Techs. We have a license and the pharmacist's license is at stake if we make mistakes on the job. We take our jobs quite seriously and wouldn't want to give a pt the wrong med. All we do all day is write down meds, fill meds, deal with meds.... That is our job... dealing with medications.
  14. by   luckylucyrn
    Quote from Diane-RN Student
    [/b]
    I have to totally disagree with your post. I am a pharmacy tech as well as a nursing student. My job as a pharmacy tech at my hospital is DOING med recs for the nursing staff in the ER.

    Trust me, even though "I'm just a tech" I can spell, and I do in fact know that "hydro something" means HCTZ......... I'm offended that you think pharmacy techs like myself can't do this type of job!

    I think she doens't mean pharmacy tech, but nurse tech. A nurse tech/patient care tech doesn't have the exposure to the meds like pharmacy techs/SOME nursing students/nurses.

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