Jcaho Medication Reconciliation

[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????

[jamato8]

It is out of our scope of practice. More grey area? I don't think so. If they want to give us more education, pay at least 3X as much and give a choice on who wants to do this, then maybe but the nurse scope of practice would have to be rewritten. We do not prescribe, and adding or deleting and giving reasoning jumps right into that arena.

[Babs0512]

We are not "adding and deleting", we are simply confirming the "patient states Ambien has been D/C and pt now takes Lunesta __mg HS"

Blessings

[silentRN]

Ya, I'm ready to do away with JAHCO. I've actually worked at a hospital that did away with them and I had no complaints.

[brashis2008, LVN]

This is ridiculous. We, at my facility, are not implementing this, neither have any of us heard of this so far.

It's not the nurses' responsibility to explain a physicians decision. We have the right and obligation to question orders if we feel it is in error, but to RATIONALIZE? RIDICULOUS. It's just extra work on us if our written justifications are plausible, but what about all the other times when the orders are in question with a particularly "difficult" physician? That's where this is going to get us in trouble.

We all know that implementing and following through on this is going to lead to a ton of falsifying or basically lying.....to get an order that makes no or little sense, to pass. Question an order and chart the action/physician response. Anything above that is picking up responsibilities and legal burdens that are not ours. It may cause a stubborn physician to rethink an order, but there are just as many physicians out there that will NOT reconsider and just start to expect that their decisions will be justified. Its then left on the nurses, from medical records/admissions, to justify anything in question.

If my facility started doing this and it became mandatory policy, I would not be staying.

[brashis2008, LVN]

I was frustrated yesterday and I think I misunderstood all of this.

Everything but the rationalization is pretty common. It's the rationale that seems a bit absurd and not in our scope of practice, so I dont see how we could be forced to do so.

[Lucky#13]

We have been dealing with the Med-Rec at our Hospital in Ohio for about a month now and it's still difficult to get compliance from the docs! I blame it on education. They started w/nursing first...3 days prior to going live! Wonderful. So, now some of the docs we have to chase down, or completely miss and have to call...which isn't right and delays the pts. discharge that much longer!

The docs need to get on board with this and really take it seriously instead of running off after writing the dc order...we can't do it all!

[cherrybreeze, ADN, RN]

Ya, I'm ready to do away with JAHCO. I've actually worked at a hospital that did away with them and I had no complaints.

Did away with Joint Commission? Exactly how do you do THAT?

[Ellekat]

Simply don't pay for JCAHO to come in; do make certain that your facility maintains state standards, however. Reimbursement may be lower, and the facility cannot say it is JCAHO certified.