Medication Reconciliation Are all hospitals doing this? - page 2
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... Read More
Dec 8, '06Joined: Oct '06; Posts: 1,256; Likes: 66Our 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.
Dec 8, '06Joined: Feb '04; Posts: 1,715; Likes: 542We 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.
Dec 8, '06Joined: Oct '04; Posts: 2,334; Likes: 3,476It'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!
Dec 8, '06Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415Oh 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!".
Dec 8, '06Occupation: RN-i (RETIRED) Specialty: ORTHOPAEDICS-CERTIFIED SINCE 89 ; From: US ; Joined: May '00; Posts: 14,479; Likes: 2,298South Carolina Hospital Association | Universal Medication Form
Our state hospital association has a downloadable form called Universal Medication List
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.
Dec 8, '06Joined: Oct '06; Posts: 1,256; Likes: 66One 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!
Dec 8, '06Joined: Oct '06; Posts: 2I 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 "
Dec 8, '06Occupation: staff nurse Specialty: critical care ; Joined: Jun '06; Posts: 58; Likes: 2medication 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....
Dec 8, '06Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415Oh 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!
Dec 8, '06Joined: Oct '06; Posts: 2k3 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.
Dec 8, '06Occupation: Jack of all trades Specialty: 20 year(s) of experience in Med/Surg, Geriatrics ; From: US ; Joined: May '01; Posts: 4,438; Likes: 3,918Quote from P_RNThat'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.
Dec 8, '06Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415I have talked to many docs about "continue home meds"...and there are a few valid reasons for that order actually.
One being that a patient may have several prescribing docs, including specialists. Most MD's are smart and don't want to re-order something they didn't order in the first place, but also don't want the pt to not take something THEY HOPE another MD is following. What is the solution when you have several appts in the clinic and several in hospital??? Continue home meds. And many that are cautious will have as part of the discharge their numbers and to call them to discuss current Rx's within a few days. That way they have their charts (in office) and can discuss this with them.
Another is the fact that the MD doesn't have pts meds memorized, and doesn't typically have the charts from their clinic. As many of us know, hospital is where you will get your meds messed up (IE the reason for these MR's)...so they would much rather see their own charts with their notes and research it. Again the reason for continue home meds till they can as not to screw up the home routine.
Now with these sheets...they still do NOT address either issue...other Rx MD's or seeing their own charts...PLUS you are going on a patients or family's word and really don't want to take a chance...those docs that just glaze over them...OMGosh! SCARY!!!!!!! But I guess they assume we check on all of them to make sure they are current and correct...Ummmmm nope...how can we??? I mean, I have seen many patients with Rx's at different pharmacies, or mail order, or list something they want again that has no Rx anymore (but once signed they do now), and unless you have time to contact the MD's office...have them fax all info on Rx's...given if their info is even current or correct (most cases not)...well, I don't have a Rx crystal ball!!!!!!!
Just having these forms wasn't the answer to making this an obtainable goal! The entire Rx structure needed to be re-designed, public service announcements and info given to the public, and healthcare training and structuring must be in place first. Nope..it was sink or swim in many cases..and the probelms just keep on comming..typically at the MD and RN level..not to mention the PATIENTS!
I wish my hospital would do this..and I have seen one that does (very smart). They have an Admit and Discharge team that deal only with these two issues. The admit team does all the paperwork involved with a general admission into the hospital (computerized), and so the RN's only have to do the admission physical assessment items. None of this MR's and other paperwork we aren't typically involved with (we have three sheets of paperwork strictly involved with social work assessments that I am sure social can handle instead of us whom are trying to simply get orders done, treat pts, clarify anything not done, etc!).
That really hit the mark on letting nurses do their jobs and care for direct patient care! And it was smooth running and happened so much faster than a nurse that must leave the room during an admit because the patient in the next room needed pain meds, an incontenent episode, help ordering dinner..etc). And that group had the policies in place for clarifying medications with the help of pharmacy and the pts PCP offices to assure medications were correct!
A team to just do admits is the way to go if they are going to have all this stuff involved. It just makes sence to me...they want it done right, you will have to pay for someone to deal only with that aspect since it is so vital!