[kbprn1]

Hi all- My first post.

I work in an approximately 20 provider clinic that has just become provider based with our hosptial. In other words, we are held to all remotely applicable hospital Joint Commission standards. We are struggling to figure out Medication Reconciliation in our clinic setting. Inpatient MedRec is pretty straightforward. Outpatient is not so much.

Currently, a nurse or MA takes or re-clarifies a written med history in our paper chart with the patient. The provider then sees the patient, and may order new meds, take them off others, or whatever. Within 48 hours the provider dictates a note for the visit, and the nurse many times doesn't see the patient after the provider. Currently, many of our providers do not dictate a full and complete list of meds after each visit. Many of our patients are not given any kind of list of their meds when they leave the clinic. Are any of you working under the same technological handicaps (no electonic medical record) and finding a way to do this that meets the standards????

[J Lynn]

God bless your soul.....20 providers! I only work for one doctor, spoiled, I know. We don't have any way of really keeping track of med changes except to hand document in the charts. Sometimes, the patient has to tell us what they are on since the doctor won't always write what samples he gave. I try to write them myself since I see every patient before and after the doc sees them. We only see about 25-30 patients a day, so it's not too hard. Would love to find a computer program to help keep track of the meds.

[Nurse Ratched]

One doctor where I go with an elderly friend has the person who is checking the patient in write a list of current meds, date it, the doc reviews it, makes changes as appropriate in the visit, initials and a copy is made for the patient before the patient leaves. Original goes in chart. This is in a practice with a lot of older folks on a lot of different meds.

In our facility, we have fewer chronic medical conditions, and those that do seem to have a better handle on their meds. The NA checking in the patient writes the list of meds, and changes are indicated by the provider inside the front cover of the chart along with acute and chronic problems.

[mkhaneja]

We are trying a system that has both outpatient and inpatient medication reconciliation. They have a great proactive site. We have a 4 person site. I fee like a monkey juggling things some of the time. But this system is cool. I think other people should try it. www.medirecon.net. We have alot of older patients and they need a list and this site does this.

MK

[ArmyMSN]

Outpatient setting here, too. Just started in my clinic this month. No reconciliation process has been in place (although Jan 2006 was JCAHO's implementation date).

Providers get approximately 20 mins per patient with a few double-booking due to increased patient load versus providers available. My organization will have a very difficult time getting them to adopt the medication reconcilation process. We're on a computerized system but it hasn't been modified to perform the reconcilation process, yet.

I'd hate to dedicate an entire FTE just for this - but I may have to in order to assist the MDs/PAs.

Hopefully someone who's gone through a recent survey in the outpatient settting can give their input.

[anticoagulationurse]

I cannot imagne the heap of paperwork with no EMR! Not to mention fetching the paper chart all the time to update, etc. God blees you for even trying! I too, work in a hospital based outpatient clinic JCAHO certified and we just finished an 18 month project for 100K lives and AHRQ.

ANYWAY, came up with a lot of good ideas and were able to standardize our med recon process. Not easy, but our med list accuracy rate (we do daily audits of 15-20 charts) has been 91-94% for over year! Oddly, it is when the patient goes into the hospital (that uses our same EMR) when the lists get most messed up.

Our patient are ALL seniors only and most have at least 10 meds up to 40. Yes, 40 meds. Try convincing seniors it's their job to know what meds they are taking! We try to give an updated med list each time they leave. With each patient, the nurse reviews the med list each time they come in (or are transferred to a facility) we clarify errors, and then the ultimate responsibility is the PCP, to verify and correct discrepancies. This gets us nurses off the hook for "prescribing" meds in the EMR.

There s NO WAY it would work if it was not a teamwork effort. Plus, JCAHO made us get rid of all our samples because providers weren't documenting them on the med list, so that has nade it easier.

One solution we tried was a local computer program that gives patients nd us a place to store their record online outsid ethe office. They can update their med list at home, we can see it. But, not many seniors do the whole computer thing, so it has had limited success. A sample can be seen at www.sharedcareplan.org

I applaud your efforts. If only the patients knew!

[ArmyMSN]

curious if any other nurses have any practical suggestions to accomplish med reconciliation.

[anticoagulationurse]

I'd like to add, after 18 months of continuing our very involved and many step med recon process, the average time to complete an established reconciliation is 2.5 minutes. Also, the process has resulted in random audits of about 125-150 med lists that reveal a 91-94% accuracy rate over the last 18 months.

Keeping in mind, of course, the list can only be as accurate as the patient reports it is. We really don't know what meds/vits/supps the patient does or doesn't take, but our best efforts have become a very routine and easy (not simple, but easy) process.

The chain of reseach for med recon goes like this:
Patient is given a copy (printed from EMR which was updated at last visit) of med list in waiting room to review and write changes. Nurse reviews list with patient upon checking patient in. If discrepancies exist, nurse researches (calls facility, pharmacy, specialist, daughter, etc.) and then notes updates that need to be made to the EMR. The PCP reviews these changes and discusses with patient during visit until agreed upon changes are made. PCP updates EMR and prints new list for patient. Patient is encouraged to contact clinic between visits to update regarding med changes. It's not perfect, but like I said, our numbers are great and it is better than ignoring the problem. Hope that helps!

[jen50]

Hi This is also my first post.I am at wits end trying to be compliant to the med recon standard. I wondered if we could design cards for patients to take home and fill out from the bottles they take at home, then bring to each ov for comparison to the med list in our charts.Unfortunately,no EMR involved here..looks like it may be awhile.Any input is appreciated! Thanks

[anticoagulationurse]

http://www.sharedcareplan.org/CarePlan/Medications/

This is a web based med record for patient use but providers can access it as well. If you contact the administrator you could see if you can use it for your patients of modify to fit your needs? Anyway, there is a printable format we give to many of our patients to fill out for their own use.