Does your facility use Medication Reconciliation forms ?

jonear2, RN · Apr 8, 2006

Yep its a jcaho requirement. i dont mind doing it on admission because we always asked about home meds on admission anyway and the reconciliation form is a bigger space anyway. the only problem is having the patients who say, "Well, I take the little white heart pill, and my water pill, etc." What are you supposed to write?

KAW1962 · Apr 8, 2006

At the facility where I work there are 2 units that are using the medication reconciliation forms on a trial basis and from what I've heard it is going well. The rest of the patient care units will go online with them starting the 17th. I am all for making the docs be responsible for ordering the meds on admission and discharge, as it should be, instead of them just writing "continue home meds." If some of the docs refuse to use them, they will be required to completely write out (especially) the discharge orders on the physicians order sheets. After all, this is their responsibility. The patients can then keep a copy of the list and produce it when they visit their doctor or on subsequent admissions. Since our admission assessments are computerized, we will be able to update the list at any time if necessary. If the patient does not know the name or dosage of a medication, have the family bring the meds in or call the pharmacy where they obtain their meds. Generally the pharmacies are cooperative. I've had instances where a patient says they take a certain med but the pharmacy told me that the med hasn't been refilled in months. In my opinion this is one of the best ideas JCAHO has come up with!

Chaya, ASN, RN · Apr 8, 2006

We've started using them both places I work. I see the necessity but I don't like 'em. It's another piece of paper we've gotta fill out and it duplicates the Md order form 90% of the time (which is the point). I'm OK with the form where you just list discrepencies but I do not like putting my name of the med list based on Pt's recollection; I'd rather write something like "Pt states he thinks he takes 50 mg of ---" and let the doc decide if that's appropriate. :uhoh3:

Dalzac, LPN, LVN, RN · Apr 8, 2006

yep they do here too but I like them. It saves a doctor to be called for a med they can just check yes or no and then we scan it to the pharmacy

sharann, BSN, RN · Apr 8, 2006

I can't wait to find out what the Joint comm causes to be on another form next year.

Burnt Out, ASN, RN · Apr 8, 2006

We do it through our Meditech. I don't mind doing it on admission because as a pp mentioned we have to ask about their home meds anyway. It is a pain if they don't know their meds and we have to call and/or remind family to bring them in constantly. I don't like it at discharge though because half of our docs never do the sheet so we have to call and clarify what meds they want their patient to continue at home.

**canoehead, BSN, RN** · Apr 8, 2006

We've been finding out some interesting things, for example the CHF/COPD patients commonly stop taking their meds because "I was too sick" about 24h before they land in the hospital. The med list our super organized patients hand us turns out to have one or two revisions when we actually go over it line by line, or the patient says "I don't take that anymore" to the consternation of family.

I would be happier if the MARs that are photocopied and sent with nursing home patients would substitute for our sheet. Now THAT is a waste of time copying them all off by hand.

Tweety, BSN, RN · Apr 8, 2006

We started using them this year.

It comes in handy IF the doc remembers to look at them and sign them and if someone remembers to print them out and put them on the chart when the discharge is pending. To often the doc writes to discharge the patient, doesn't ask for the med reconciliation, then we have to call the doc when we see the order and clarify it.

It's a pain though when someone is going for multiple procedures and surgeries, they have a ton of reconciliations.

As usual JACHO requirements in the end make for more work and more paper.

mkhaneja · Sep 4, 2006

We use and electroinc form at our 4 person site. www.medirecon.net. We need to use this due to the fact that we have older patients and this electronic system allows us to print wallet cards and everything.

nrsjo · Sep 4, 2006

We use med-rec forms that are computer generated based on what meds the patient states they take at home. However, as is par with our computer system, it is not a perfect system. Nursing not only has to get the docs to sign it, but then has to remember to fax it to pharmacy or the patient will not get any of their medicines. It really shouldn't be this hard.....

Antikigirl, ASN, RN · Sep 4, 2006

Yes, we have been using them for a few months now. Yeah, yet another piece of paperwork to do on admissions, but it does help the patient so much about what they should be taking at home!

Con side:

The trouble we are having though...the MD's haven't quite gotten the hang of these and either forget to circle C (continue) DC (discontinue) and sign.

Many MD's don't really like this because they are basically reordering something they didn't prescribe in the first place! I don't blame them for that!!! I have had to tell eager patients they will have to wait on discharge because the hospitalist will not sign for things they did not order! But hey...I understand, I don't sign for meds/treatments I didn't do! So there is a big downer about this!!!!!

Old lists or patient unable to give accurate history, there is a box for this and an area to explain why...but I rarely can rely on pt recollection because with some...they would have to be a a pharmasist or other healthcare provider just to understand their med lists!!! That is dangerous and what MD will sign these orders with certainty??? AND I know I can't put "Blue pill, two daily when I feel like it, then White half pill that makes me pee alot in the morning along with the other white little pill I can't remember". Unless you have a real med list, and the patient recalls if it is current...I do find them dangerous to the patient!

On the pro side though:

When I worked at an ALF, we would constantly get people comming home that didn't have a continue order, or they didn't order any of their old PRN's and we would have to call, fax, and get those orders. Now, this took hours if not a few days. Having that there...IF filled out entirely, really helps LTC's, SNF, and ALF's big time (since most of those need orders for even lip balm or sunscreen!).

I think it would be a huge help if those facilities had those filled out and ready at all times to send with their patients!!! Or at least updated every three months with their 90 day orders. I would have done that just to save myself hours/days having to correct things back to normal after a hospital stay!!! LOL! Most do send the MAR's though..that is helpful (copies...our facility would copy them fast and send them with the patient along with their POLSTS and face sheet).

As far as other people...if theytake more than 3 medications, they should have a list available in the car, wallet or whatnot so it is easily copied! So far I have been lucky and have people that do have printed lists of their medications, dose, times, and prescribing MD! I love those guys! LOL!

SO there are pro's and cons, but I think unless the PCP for that individual sends accurate prescription records (or facility sends updated MAR's)...it can actually be dangerous and a HUGE liability for hospitalists. And if that is done, I can see it being a bonus except for all the darned handwriting while I am trying to care for patients!