[Charlie77]

I have another question on this new "policy". Upon admission say the patient is unable to answer what meds they are on, there is no transfer sheet and you have to go by the H/P from the ER doc. Then you have to call the pharmicies and maybe the doc's office to add to the list. Now how accurate is all of that?

[catjolpn]

Our hospital uses the guidelines set by JACHO for med reconcilliation. If a physician fails to sign and check off on the home meds, we (nurses) call them and get the meds reconcilled over the phone and then they are required to sign forms within a specified time limit. Yes! nurses are overwhelmed most of the time but we also have a Charge Nurse on our floor who can handle this function if we are not able to at the time of admission to our floor. Most of our physicians are compliant with filling out the forms before patients are sent to us. We all need to be vigilant concerning our patients safety and well being.

We also now have the MAK system in our facility. It is one of the most relliable systems to cut down on medication errors when used properly. Even with that we need to be vigilant.

[softstorms]

I can not make any dx. Way beyond my scope. To chose a drug? WAY...WAY beyond my scope.

[MedSurgeNewbie]

We having been doing one on admit and one on discharge, I try to get the discharge ones filled out with existing meds, and put it in the chart near the discharge summry so the doc's will see it and fill it out still end up calling and getting verbals the majority of the time

[childpsychnurse]

The med recon is supposed to be an MD task-yet do any of us have doctors that actually make it a priority? Most of my admissions are VTO-with "continue whatever home meds they are on". Then, we have the client or representative that doesn't know doses OR, in the CD field, patients that are figuring out all they have to do is say they are on something and it gets "continued". We are suposed to call the MD back and get confirmation after admitting, but it doesn't correct dosage errors or clients that get sound alikes confused, too.

[Colorado1]

I have heard, more than once, contradictions in what Joint Commission requires when compared hospital-to-hospital. This leads me to believe hospitals sometimes use it as an excuse for implementation of new policies or procedures. I truly can't imagine them saying nurses need to provide the ratioale.

In our facility, the Medication Reconciliation is printed whenever a patient transfers from ICU to another floor, and the night before the patient is expected to discharge (put on front of the order section for the doc). Our printout includes both home meds (in lower case) and all those taken in the hospital (IN UPPER CASE). Then when the doc comes in he simply checks the box in the "continue" column for any he wants to carry forward. If the patient's discharging, the nurse then makes these edits to the home med list which then prints out from the system. It's a great benefit to the patients to have such a clear picture of what they're supposed to take and when.

[gotnurse333]

Originally Posted by SEOBowhntr

Recently our facility have implemented a plan of MEDICATION RECONCILIATION in which the nurse is required to provide rationales for why a physician did not continue a patient's home medications, and re-rationalize with transfers, after a surgical procedure, and upon discharge. I wondered how other facilities are doing this MEDICATION RECONCILIATION process. I have a letter at the STATE BOARD OF NURSING, NURSE PRACTICE committee right now and am awaiting a response on their stance on this issue.

I firmly believe that MEDICATION RECONCILIATION is a PHYSICIAN'S RESPONSIBILITY, not a nurses. Furthermore, nurses willing to assume such responsibility would seem to be opening themselves up to a liability issue that we as nurses really shouldn't be involved in. How are other facilities around the country completing medication reconciliation????

At our facility, we write in the medications on the reconciliation form and the doctors check whether to continue the med or not on admission, on discharge they check on the same form whether or not to continue the medicine. However, they do not offer a rationale in writing as to the reason for continueing or D/Cing the med, the only way to find out is to ask the doctor or go through the progress notes(assuming they wrote down the reason) We are just responsible for making sure the doctors don't forget to do it

[Roy Fokker]

Originally Posted by gotnurse333

At our facility, we write in the medications on the reconciliation form and the doctors check whether to continue the med or not on admission, on discharge they check on the same form whether or not to continue the medicine. However, they do not offer a rationale in writing as to the reason for continueing or D/Cing the med, the only way to find out is to ask the doctor or go through the progress notes(assuming they wrote down the reason) We are just responsible for making sure the doctors don't forget to do it

Ditto here... and what a job it is in getting them to do it.

Some of them don't even look at the damned thing - they just check "Continue" on all of them.... even if they are IV meds and the patient is being discharged !

The surgeons are the worst!

[creature]

We have been doing this for awhile. We came up with our medication reconciliation form. It gets started in the ER. The nurse writes the patient's home meds, the doctor goes over each and checks continue, hold or d/c, then on admit he will order meds as reconciliation. The nurse then has to write all meds out on order sheet. Upon discharge the nurse writes any new meds on this same form, the doctor goes over it and marks the ones he wants them to be on at discharge. It has worked out pritty good for us.
Creature

[Nellie Nurse]

I work on an ortho/neuro unit where the doctors are babied. Our med reconciliation forms used to be order sheets that the doctors could check mark DC or continue but none of them used the order form the right way. So now the med rec form is put in the progress notes for review and then the doctor is supposed to write an order for which meds to start. The hospitalists and internal med docs are usually pretty good about writing out which meds to start but the darn ortho/neuro docs will write, "Continue home meds." Well we can't write out a clarification order and list the meds as listed on the med rec form so we must then call the doctor and read the list to them and get approval for each med. Half the time these guys don't even know what the medication is!! Then we have to listen to them ranting and raving about being paged blah, blah, blah. Then when the pt is discharged we have to do the same thing all over again and write out all of the meds to be DC'd on. It is a lot of work and is really frustrating.