Med Recs

[budger1983]

Hey everyone, gots a question for you. Anybody familiar with having to provide a medication reconciliation for patients being discharged from your EDs? I was just informed by my nurse manager that we have to devise a system to provide patients with a med rec that has all of their meds on it not just what is being added or changed. This is going to be time consuming as all hell if I have to write or type out every medication and dosage for every patient that comes through our ER as we have no unit secretary, just 2 RNs and a doc. This came to us via. a JCAHO representative.

Any and all advice or ideas are more than welcome.

[grammyr]

We do them on everybody who has home meds and if they get a RX before they leave. Kinda sucks to do them on headaches,toothaches,etc but we have pretty much gotten into the habit. We use paper charting so it takes a while for the patients who have a lot of meds.

[June55Baby]

I heard that this requirement comes, in part, from a case where a patient came into the ER with hypertension. He was on a blood pressure pill as a home med, but the ER doc prescribed a different pill. Apparently, the man misunderstood or was never instructed to discontinue the first bp pill so he was taking two. Later he saw his primary care physician who not knowing about the change put him on yet another bp pill and again the man was not instructed properly or misunderstood and took 3 pills. A few days later he came back into the ER with no blood pressure at all and died. At that time it was discovered he was taking 3 pills for hypertension and the action of the 3 pills finally caught up with him.

[sorefeet]

We are doing this at our facility also. It is time consuming--but what are you going to do! It becomes difficult when you have so many patient can't remember the name of their meds or do not know the doses---we try to do as "complete" a list as possible. We have a comment area available and make sure and write a comment such as: meds from pt list, list from pt memory, pt cant remember doses, list from medics names but not doses given, etc....

[nuangel1, BSN, RN]

We are doing this at our facility also. It is time consuming--but what are you going to do! It becomes difficult when you have so many patient can't remember the name of their meds or do not know the doses---we try to do as "complete" a list as possible. We have a comment area available and make sure and write a comment such as: meds from pt list, list from pt memory, pt cant remember doses, list from medics names but not doses given, etc....

i have even called pharmacy to get med list .this is all too time consuming for er when we have 4-5 pts .i write the same comments on ours.

[8great]

We also have to do this, takes too much time, parents often don't know the names or amts of the meds that their kids are taking. Look this up on the ENA website, they're pushing hard to not have this required in the ED. Our physicians refuse to sign the forms, but the nurses are written up if the forn is not completed. One more nutty thing to take the nurse away from the bedside.

[canoehead, BSN, RN]

I heard that this requirement comes, in part, from a case where a patient came into the ER with hypertension. He was on a blood pressure pill as a home med, but the ER doc prescribed a different pill. Apparently, the man misunderstood or was never instructed to discontinue the first bp pill so he was taking two. Later he saw his primary care physician who not knowing about the change put him on yet another bp pill and again the man was not instructed properly or misunderstood and took 3 pills. A few days later he came back into the ER with no blood pressure at all and died. At that time it was discovered he was taking 3 pills for hypertension and the action of the 3 pills finally caught up with him.

If the patient was under the impression he had to take all three pills, then at our hospital we would not have questioned him, especially if he had all three prescriptions. We would have taken him off something if he had a crappy BP, but we'd do that even without the med rec form. How would a med reconciliation form prevent this from happening?

[RunnerRN, BSN, RN]

We started doing this sometime last yr. We have a page that has a carbon copy, and we have to write something on every patient, even if it is just "unk BP med" etc. I'm really good at doing that. The problem comes when people are d/c'd. We are supposed to write out any changes (in "real person language" - no prn, tid, bid) and add any meds that have been Rx'd that day. Then we keep the top sheet and give the carbon copy to the patient. We do not have comp charting, and it is a big pain in the you know what.

[911RN]

Yes, they are certainly a PIMA. If the pt does not know the meds, we are required to call the pharmacy and get the list. Jacho is also now requiring smoking cessation questions/counseling for every pt, and nutrition counseling.

I can understand this for admitted patients, but for the average toothache, suture, or cold sx pt it can be alot of time. We have a FF pt who comes in sometimes 2 x a day, with a med list 2 pages long that we have to write up for each visit.

[KNARE]

I would suggest Google Medication Reconciliation and choose the JCAHO link dated 2/07. It is a question/answer teleconference that I found very informative / helpful..... It had specific information related to the ED.