[TaraER-RN]

Hi everyone...we have been having to do med recon's in our ER for about the last 4-5 months. It has been getting easier...all we (as nurses) are responsible for is printing their med recon sheet (since I work for an HMO the patient's meds will print out as long they get them filled at one of our pharmacies), and then we are to go through the list with the pt and just list "taking or not taking" we don't have to put the last dose, how much etc...and we are suppose to list any herbals or OTC's. At that point prior to going home the ER doc or admission doc (if they went up to floor) are suppose to reconcile it and the pt gets a new sheet on discharge telling them what new meds they have, what to cont to take, and what to d/c. But we in no way are responsible for a "doctor's rationale". I have been told that JACHO likes the way we do it....

[Fan of 4 points]

We are in Mechanicsville, VA and we are responsible on admission for filling out the med rec form and scanning it to pharmacy. We are supposed to write down the time and date that each med was last taken and circle yes if the MD ordered it on admission and No if he didn't. We are supposed to sign under a statement that says we have consulted the MD reconciling the meds (i.e. regarding omitted meds). We have been told that we can put lines through that statement. But I totally agree with you that it's the MDs job to get an accurate list of home meds. Besides, who is going to call an md at 0300 for a home colace, vitamin or other such non-urgent med???

[10MG-IV]

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????

#1 I would dare any JACHO monkey and I am afraid I am insulting the MONKEY here, to follow and keep up, while taking care of the volume of patients we do in the ER, and then some how add time to my already insane day to chart a med recon page, Patients now have 8-18 meds. ,ie: "a bp med and sumthin for my gout" 30% of the MD's look at the sheet and if they wanted to know THEY could go ask while they are doing THEIR history and physical FOR GOD's SAKE. That is a run on sentence folks.......but it is 0400, and Insonmnia and I are up ranting now,


#2 Were are our kahaunas?? When are we going to say, NO, NAY NAY, NO WAY, NOT GONNA DO IT..... AS A COLLECTIVE GROUP?????
NURSES ARE WOOSIES AS A GROUP I know I have been one for 30 years,seen 'em, yelled and screamed, jumped up and down, we are sooooo passive aggressive it makes me, well CRAZY..... in the ER most patients don't recall medication name time last taken or dose, and I am happy to write that down. I spoon feed my children I should not have to spoon feed a 34-70 year old doctor. If we all do it maybe they will get the MESSAGE AND LEAVE US TO DO WHAT WE ARE TRAINED TO DO AND DO BEST, PATIENT CARE
This is not what Florence intended.....
a side note....,
PHARMACY WROTE ME UP FOR WRITING DOWN A DOSE OF A DRUG AS
84 MG, WHAT THE PATIENT HAD WRITTEN DOWN ON HIS "DRUG LIST"
SO IT WENT LIKE THIS "BIGPILLAGUSS, 84 MG. PO DAILY "
THE PHARMACY SAID BIGPILLAGUSS IS 8.4 MG NOT 84 MG, I SAID, YOU WRITE DOWN THE MEDS THEN, B/C THAT IS WHAT IS WRITTEN ON THE PATIENTS "LIST".and, btw where is my heparin drip and insulin drip you are suppose to mix,,,, since I am too inept to mix my own in the ER now..I AM WAITING....... When I write any med recon list I add .....this list MAY NOT BE ACCURATE TO DRUG NAME, DOSE, TIME LAST TAKEN, CHECK WITH PATIENT
AND YES I AM SHOUTING......

[Babs0512]

I disagree, it is a MD's problem to get med reconciliation AND the nurses responsibility. Come on guys (gals) think about all the mistake Doc's make, do you want to depend on their assessment alone?

How many patients do we have that go to the PCP, the Cardiologist, the pain clinic, the urologist, etc... how can we be sure that the list of meds the admitting PCP has is correct? Might it be possible that the PCP hasn't been notified of a new med one of the other doc's put the patient on?

That's is where we come in. We ask for a complete list, add and delete meds accordingly, and then it is up to the PCP to take it from there.

It's part of the admissions assessment, the preoperative assessment, and it's here to stay if you want to be JACHO accredited. And it makes sense! Too many errors were being made.

Sometimes it's just best to go with the flow, we have more important nursing issues to talk about. That's my worth.

God bless

[TexasNurse2008]

We do the med-rec - but rationale?? Where did that come from? Just another form of pencil-pushing that takes away from real patient care. Ridiculous!

[Babs0512]

Suggestion for 10mgIV: photocopy the patients med list that they give you from now on, and place it with the chart. That's what I've started doing. It many help to avoid a problem in the future. Just a suggestion

[embarrasingfield]

OMG- yet another reason this field is so embarrasing.

[Angie O'Plasty, RN]

Originally Posted by TexasNurse2008

We do the med-rec - but rationale?? Where did that come from? Just another form of pencil-pushing that takes away from real patient care. Ridiculous!

Wouldn't the rationale to be to get the patient the correct meds based on what they were taking at home?

I mean, if you had no idea of what the patient took, how could you know enough to do a Dig level or whatever? And then, all the meds get changed and the patient is sent home, to do what? Continue the home meds and add the new ones?

At least with the Med Rec forms, it's pretty clearly spelled out to help the patient understand what he's taking, what he's not, when, and what for.

To me, that IS a big part of patient care.