Medication Reconciliation Are all hospitals doing this?

Nurses General Nursing

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Is this a universal thing these days? I was talking to a traveler the other day and he said that many places of doing this.

Is this going to turn out to be just another useless form, or has anyone seen some concrete positives come out of it. There've been some problems where I work. The nurses are hurrying to get the forms done, some of the docs are blindly signing them off. I notice it's a bigger problem when the admiting doc is not the primary doc for the pt. Also, some of the older pts are tinkering with their prescribed doses at home, they give us the info, we write it on the med-rec sheet, the admit doc takes it as the gospel, and then there is an error. I had a pt who ended up being over metropolized on a double dose which he had also been mistakenly taking at home. He was having some pretty significant non sustained bradycardia, and when I called the primary he said that the dosages, which had been taken off of med-rec by pharmacy, and had been incorrect.

My point being that med-rec is sometimes creating more problems than it's solving. Also it's timeconsuming. I haven't given up on it yet, but I'm losing hope.

We have a Med Card we have to make for every D/Ced pt. all the current meds, dosages, frequency are listed as well as a Pt's allergies.

I have a list as you describe in my wallet & have made lists like these for my DH & my Mom.

Also, right along with that, I carry a copy of my Advance Directives; I actually also carry a copy of my Mom's since I am her POA for Health Care.

Mary Ann

When I admit a patient that carries lists like these, it makes my day!!

Our hospital is not Jaccho at this time, we are a rural hospital that is designated Critical Access. I think management is trying to head in that direction, however.

I find that many Jaccho type edicts often come out of what appears to be academia. By that I mean that it's not based on the practical realities of bedside nursing, but was devised in an office by someone with a Masters or PhD, but not much common sense. It also seems NOT to take into the consideration the reality of the time/space continuim, and the fact that adding a timeconsuming bookkeeping task to the bedside nurse's duties does not also add more time to the 24 hour day.

One positive that came out of this is that the hospital did a local media campaign on the local radio stations encouraging the public to get with the program and I'm seeing more pts with comprehensive med lists. That's the key, to educate the public. I don't like it when the nurses are mandated to shoulder what should be the patient's responsibilty.

I'm also finding that there's not much common sense, that we are spending lots of time doing these forms on pts that will be out of the hospital quickly. Management is QAing the whole process, and all they care about is how the bar graphs look, meanwhile I'm not seeing that it's improved pt safety or care. And the docs are seeing it as a shortcut for them, so they like it.

Specializes in Med Surg/Tele/ER.

We use these too....nursing fills it out & signs, the doctor just checks off what he/she wants to continue & signs. Fax it to pharm & we are done. When a pt can't recall dosage/time taken then pharm does the calling to their local pharmacy to get the info.

It's a PITA. The nurses have to fill the sheet out upon admission, with info from the patient/family which is frequently incorrect, the doctor blindly signs it ordering meds that are incorrect or make no sense and then pharmacy sends it back to the nurse for clarification. Great fun! Not!

Specializes in Education, Acute, Med/Surg, Tele, etc.

Oh Lordie yes, and what a PAIN! We had forms like it before, but now they pumped it up five notches and made it an absolute pain for everyone involved!

I also noted recently that our pharmacy will not deal with these, and won't call the MD for clarifications...they send it back to the nurse to do! I have tried to clarify these many times (I work swing...so late night calls to MD's are getting them mad because of this!), get an answer...and it isn't good enough for pharm or still not correct! UHGGGGGGG...could have saved a step if they just called and asked the questions THEY wanted to ask and talk with the physician about what to use if we don't carry it!

The other day I had to call 7 docs because they ordered Ambien CR...we don't carry it. How is this my fault and why do I have to use up my time for tending patients calling ticked off MD's! I told the MD's to please say something about this and maybe if the RN's and MD's say something we can make it workable...but if the MD's don't (cause you know nurses do!) it won't work!

I don't mind a MR sheet that is simple to use and user friendly, as long as there is a campaign by the powers that be to make a big public service message goal of writing all your meds down and keeping it updated and on your person at all times!!!!!!! How much you willing to bet that's ever going to happen?????

At this point it is just another darn form that keeps me away from doing my other duties and keeps me at the desk on the phone with frustrated docs! I didn't sign up for Nursing to be a full-time secretary too...that is just too much for anyone to do (since the addition of these new forms...I spend at least an hour per shift on the phones finding docs that now are getting smart and not answering!)!

I even had a sweet awesome doc say "These forms are going to send me into early retirement!". I didn't giggle because I knew he was essentially serious..I nodded my head and said "you and me both!".

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

South Carolina Hospital Association | Universal Medication Form

Our state hospital association has a downloadable form called Universal Medication List

https://www.aikenregional.com/files/UMF_0106_1.doc

You may want to d/l one for yourself.

And it makes it so easy to reconcile meds. I had some surgery a while back and the surgeon said he was really impressed. My husband and I both carry one in our wallets.We alsohave ours on a jump drive on our keychains.

The hospital can provide one to discharged patients, who then can carry it with them to their doctor's visits. I know several states are considering using this same form.

As far as "continue home meds" I recall one new nurse obtaining a list of meds and calling the doc for confirmation. He approved all and it went to the pharamcy. One of the meds was LORTAB. (This was when Lortab was fairly new.) This patient got LORTAB every four hours!

No one caught it on the initial med check, the pharmacy didn't catch it the surgeon didn't catch it. So the patient even as a post-op got their pca AND the LORTAB . It was caught at the midnight chart check by an experienced RN.

One thing I'm finding is that the pts are putting every darned med and herb that they are on, the docs are blindly checking them off, and I'm having to hand write out stuff like glucosamine/chondroitan for a rule out chest pain pt, who ends up being discharged the next day after 4 negative troponins with a new med for heartburn. We don't carry glucosimine/chondroitan in our pharmacy, thank you very much, duh! And, they don't need it while they're in stepdown for a RO MI. Doesn't anyone have any common sense.

Another thing is that, if they are there for exacerbation of CHF, there shouldn't be a whole rigamorole and big ta do if their Lasix is changed, duh! Of course their Lasix is changed, THAT'S WHY THEY'RE IN THE HOSPITAL!

I work in a rural hospital ED. We do the med recs on admissions but starting January we will do them on every pt. The problem - we have many repeat pts that come in sometimes daily with bogus back pain, dental pain, HA, with med lists over a page long. How time consuming will that be? Or the ones that say "My doctor knows what I take" or "I've been here before you should have that "

Specializes in critical care.

medication reconciliation is mandated by our hospital upon admission & we call the md if he wants it continued or not.that is not the only thing we do on admission, we have to do a palliative screening, a password, the core measure(AMI, Pneumonia & CHF).these same papers, are to be completed again on discharge & if the diagnosis is one of the core measures, we have to complete more paperwork & again document in the computer) & like if beta blocker or ACEI/ARBs are not ordered, you have to document why it was not ordered & if md did not explain why, we need to call the md & ask him why & document it again.plus, we have to document if flu/pneumonia vaccine given if not why or if it was given previously.

IT'S a LOOOOOOOT of work on top of the nursing supervisor pushing on admission but we have to do it as all these papers have to be inspected by our chanrge nurse.

CRAZY...i know it is....

Specializes in Education, Acute, Med/Surg, Tele, etc.

Oh man the vita's and naturalpathics! UHGGGG! In this day and age these two disaplines have still not met!

What happens when we have those...we have the pt family/friends bring them in. Then pharm has to label them and send them back to us so we can use them. And what is really sweet is when those are expired because they bought a big old bottle of them on sale...and we can't despence. GRRRRRRRRR! (had that happen few to many times!).

To make matters even worse...I am an advocate for giving the medications we give back to the patient because they paid for them! We do daily meds for pills so usually that isn't an issue, but I do this for inhalers, creams, drops, etc. Now even that seems to be a big thorn in pharmacies side and it takes over 8 hours to get them back...not helpful when the pt is leaving!

Thanks to the MR's, everyone is so deep in paperwork and clarification that we are ingnoring the basics of it all...good quality service that is safe and (my hospital misson statement) fically responsible! "Oh I am sorry you had an incontenent episode...just hold on because I am on the phone with your doc to clarify your Ambien, and naturalpathic meds". Yeah right..grrrrrr!

k3 that sounds like a nightmare! We have created such a dependent society. People need to be more accountable for their personal health care and quit expecting "Someone else" to take care of things. If they take meds they need to know what and why and carry a list.

Specializes in Med/Surg, Geriatrics.
That's what I was thinking. This is something I have been doing forever and a day.

In addition to family/patient memory, I've called pharmacies, PMPs etc. to try to get an idea what the little white pill with the words or is it numbers on one or both of the sides.

I carry a Universal Medication Sheet as I myself can't always remember all my meds.

Yeah, we've always done it only it wasn't called "medication reconciliation" of course.

The official medication reconciliation movement is as one of JCAHO's national patient safety goals. It was necessary because of orders like this:

"Continue home meds".

This was a function of lazy doctors who didn't want to be called to be asked if their patients should continue the 20 home meds they were taking, many of them they couldn't even remember why they were taking in the first place. So people were admitted into the hospital and given meds that should have been discontinued or just as bad, meds were discontinued which should have either been continued or a suitable substitute made.

I hate the medication reconciliation sheets because they are just another form for the docs to ignore and for which the nurses have to chase them down to sign, etc. etc. But I understand why they were created.

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