[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????

[earle58]

this is news to me.
any doctor i've worked with, has had to provide their own rationales for any orders they've written.
and that's the way it should be.

leslie

[sabRN2b05]

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 hospital, our docs/nurse practitioners are responsible for checking a box ("C" for continue and "DC" for discontinue) on the MAR and THEN they have to look at the "home meds" sheet and check "C" or "DC" (e.g., some drugs may have been on hold at admission, dosage changed, etc). Of course, some docs had to be "broken in" when this process was first implemented. It was a royal pain in the a** when it first started, but soon they became used to it. We still have to go behind them, make sure everything matches up (e.g., they may check to d/c something on the MAR, but then continue it on the home meds sheet, or they may check continue on a drug that the pt was not on at admission and then the MD forgets to leave a Rx for it when the pt is d/c'd.). Quite tedious, but I understand the rationale behind it.

Never heard anything about the rationale thing you are talking about....not really within nursing scope of practice IMHO.

[TazziRN]

Originally Posted by earle58

this is news to me.
any doctor i've worked with, has had to provide their own rationales for any orders they've written.
and that's the way it should be.

leslie

bingo

[lsyorke]

Medication Reconciliation is a new Joint Commission standard(or at least that's what we're told). We've been doing it for a few months now.Patient meds from home are listed on admission. Each one has to be addressed(by the nurse) as continue, or discontinued and the reason. It is done again on discharge for all meds.

[SEOBowhntr]

Originally Posted by lsyorke

Medication Reconciliation is a new Joint Commission standard(or at least that's what we're told). We've been doing it for a few months now.Patient meds from home are listed on admission. Each one has to be addressed(by the nurse) as continue, or discontinued and the reason. It is done again on discharge for all meds.

You see Isyorke, that's the problem, the nurses shouldn't be held liable for making rationales for why a physician discontinues a med, that is HIS/HER responsibility. I am fighting that battle right now as Upper Mngmt it trying to shove this down our throats. My license doesn't allow me to order/discontinue medications, therefore I really don't have in my scope making rationales for why medications are discontinued. This is the issue I am currently awaiting the state board to clarify to me so I can go to the D.O.N. and tell her to take it from the state board, since she won't listen to me. I'm probably just about to shoot myself in the foot, but "You've Got to Stand For Something!!!"

[TriageRN_34]

Our docs fill out the forms with a circle with a DC or C...that is THEIR responsiblity!!! They need to rationalize it not me...considering I can not prescribe medications or take on MD responsiblities...I certainly won't take that one on!!!

Only way I would EVER do it is if they have a check box for me to check "heck if I know!!! Ask the MD!"....

That is simply INSAINE!!!!!!

[earle58]

it would be interesting to hear jcaho's rationale as to why they think nsg should be doing this.
i'm sensing (and i hope i'm wrong) they're perceiving nurses as the md's hand-maiden......almost secretarial in nature.
i think it's a fight worth fighting.

leslie

[SEOBowhntr]

Thanks for the replies, I actually plan to use some of the responses on this forum in my case against why it is completely absurd to expect nurses to do this. I have no problem tabulating a list, but I absolutely am not making rationales for a physician's decisions.

[lsyorke]

Oh, I completely agree, this is not a nurses responsibility. It adds more work for something that a doc should be doing.. and compliance by nursing is horrible because no one has the time. Supposedly this came into being due to patients not being given medications that they were on at home, some important meds. BUT that is not our responsibility. I'm totally with you on this!!!