Jcaho Medication Reconciliation

leslie :-D · Jun 8, 2006

this is news to me.

any doctor i've worked with, has had to provide their own rationales for any orders they've written.

and that's the way it should be.

leslie

sabRN2b05, BSN, RN · Jun 8, 2006

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????

At our hospital, our docs/nurse practitioners are responsible for checking a box ("C" for continue and "DC" for discontinue) on the MAR and THEN they have to look at the "home meds" sheet and check "C" or "DC" (e.g., some drugs may have been on hold at admission, dosage changed, etc). Of course, some docs had to be "broken in" when this process was first implemented. It was a royal pain in the a** when it first started, but soon they became used to it. We still have to go behind them, make sure everything matches up (e.g., they may check to d/c something on the MAR, but then continue it on the home meds sheet, or they may check continue on a drug that the pt was not on at admission and then the MD forgets to leave a Rx for it when the pt is d/c'd.). Quite tedious, but I understand the rationale behind it.

Never heard anything about the rationale thing you are talking about....not really within nursing scope of practice IMHO.

TazziRN, RN · Jun 8, 2006

this is news to me.
any doctor i've worked with, has had to provide their own rationales for any orders they've written.
and that's the way it should be.
leslie

bingo

lsyorke, RN · Jun 8, 2006

Medication Reconciliation is a new Joint Commission standard(or at least that's what we're told). We've been doing it for a few months now.Patient meds from home are listed on admission. Each one has to be addressed(by the nurse) as continue, or discontinued and the reason. It is done again on discharge for all meds.

SEOBowhntr · Jun 8, 2006

Medication Reconciliation is a new Joint Commission standard(or at least that's what we're told). We've been doing it for a few months now.Patient meds from home are listed on admission. Each one has to be addressed(by the nurse) as continue, or discontinued and the reason. It is done again on discharge for all meds.

You see Isyorke, that's the problem, the nurses shouldn't be held liable for making rationales for why a physician discontinues a med, that is HIS/HER responsibility. I am fighting that battle right now as Upper Mngmt it trying to shove this down our throats. My license doesn't allow me to order/discontinue medications, therefore I really don't have in my scope making rationales for why medications are discontinued. This is the issue I am currently awaiting the state board to clarify to me so I can go to the D.O.N. and tell her to take it from the state board, since she won't listen to me. I'm probably just about to shoot myself in the foot, but "You've Got to Stand For Something!!!"

Antikigirl, ASN, RN · Jun 8, 2006

Our docs fill out the forms with a circle with a DC or C...that is THEIR responsiblity!!! They need to rationalize it not me...considering I can not prescribe medications or take on MD responsiblities...I certainly won't take that one on!!!

Only way I would EVER do it is if they have a check box for me to check "heck if I know!!! Ask the MD!"....

That is simply INSAINE!!!!!!

leslie :-D · Jun 8, 2006

it would be interesting to hear jcaho's rationale as to why they think nsg should be doing this.

i'm sensing (and i hope i'm wrong) they're perceiving nurses as the md's hand-maiden......almost secretarial in nature.

i think it's a fight worth fighting.

leslie

SEOBowhntr · Jun 8, 2006

Thanks for the replies, I actually plan to use some of the responses on this forum in my case against why it is completely absurd to expect nurses to do this. I have no problem tabulating a list, but I absolutely am not making rationales for a physician's decisions.

lsyorke, RN · Jun 8, 2006

Oh, I completely agree, this is not a nurses responsibility. It adds more work for something that a doc should be doing.. and compliance by nursing is horrible because no one has the time. Supposedly this came into being due to patients not being given medications that they were on at home, some important meds. BUT that is not our responsibility. I'm totally with you on this!!!

medsurgnurse, RN · Jun 8, 2006

So now we are mind-readers? I mean nursing knowldge will help you figure out why a medicine was d/c'd. But how do we know what the physician's rationale is unless the physician WRITES IT OUT ON THE DISCHARGE SHEET.

Home Health Columnist / Guide · Jun 8, 2006

jcaho sentinel alert

issue 35 - january 25, 2006

using medication reconciliation to prevent errors

medication reconciliation is the process of comparing a patients medication orders to all of the medications that the patient has been taking. this reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. it should be done at every transition of care in which new medications are ordered or existing orders are rewritten. accurate and complete medication reconciliation can prevent numerous prescribing and administration errors.

assign responsibility for comparing admission orders to the home medication list, identifying discrepancies, and reconciling variances to someone with sufficient expertise. ....
creating a process for reconciling medications at all interfaces of care (admission, transfer, discharge) and determining reasonable time frames for reconciling medications. patients, and responsible physicians, nurses and pharmacists should be involved in the medication reconciliation process.

--

ismp medication safety alert, april 21, 2005, http://www.ismp.org/msaarticles/20050421.htm

...we have outlined the steps we suggest for implementing this process.
obtain a medication history. obtain the most accurate list possible of the patient's current medications upon admission to the organization before administering the first dose of medications (except in emergency or urgent situations). this includes prescription and over-the-counter medications (including herbals and dietary supplements), listing the dose, route, frequency, indication, and time of last dose. most organizations use a specific form for this purpose, on which an assessment of patient compliance with drug therapy and the source of the medication history information can also be documented. besides the patient and family, other sources of information may include visual inspection of the medications brought into the facility by the patient or family, previous medical records, as well as the patient's pharmacy and physician office.
prescribe medications. as soon as the list is reasonably complete, have the prescriber review and act upon each medication on the list while prescribing the patient's admission medications.
reconcile and resolve discrepancies. require another person to compare the prescribed admission medications to those on the medication history list and resolve any discrepancies.
reconcile again upon transfer and discharge. each time a patient moves from one setting to another, review previous medication orders alongside new orders and plans for care, and resolve any discrepancies. when the patient is discharged, the reconciled list of admission medications must be compared against the physician's discharge orders along with the most recent medication administration record. any differences must be fully reconciled before discharge.
share the list. communicate a complete list of the patient's medications to the next provider of service when transferring a patient to another setting, service, practitioner, or level of care within or outside the organization. this includes sending a list of medications prescribed upon discharge from the hospital to the patient's primary care physician, as well as encouraging patients to share the list with their pharmacy.
the joint commission requires hospitals to initiate this type of medication reconciliation process now. full compliance is expected by january 2006.

share the list---- only 2 out of six health system facilities share this list with my homecare agency despite this being 2006 safety goal.

last night was trying to set up homecare at 6:30 pm from doctors faxed rx with patient name only; no dob, address or phone number. saw similar name in my computer data base, called patient and he confirmed had requested rx from this doc as lle wounds reoccurred. that's typical of the type of referral my homecare agency receives. try and get med list from pcp's nearly impossible!

20% homecare patients discharged from facilities without any medication rx too. huge issue that mushroomed as average homecare patient takes eight rx medications when we've done chart audits.