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????

[grammyr]

I guess you could just put "I dunno!!!!" That is a sort of rationale and very much the truth some times. :rolleyes:

[Antikigirl, ASN, RN]

I wish the ER would do these, but in our facility this isn't done unless the patient goes to a floor and we have to do it ALL! I get a small list from ER if able (the old blue pill white pill you get in ER all the time), and I have to take time to call family or facilities if available and get it all straightned out...along with a skin care sheet, friction and sheer risk sheet, fall risk assessment sheet, admin hx and assessment, nursing note assessment (on top of all the other assessments I do for that one pt...oh no, need it rewritten for a different section of a dang chart ya know!), a questionaire about potential abuse and finance questions (if they feel they can't pay then that triggers certain services), a full sheet on pt teaching, another on potential service/teaching needs for the kardex, bands hand written with allergies, and lets see...oh the MD order sheets and another for potassium protocol, PCA, or CIWA scales and what not! Okay an average of 2 hours if not more just in paperwork alone, no wonder people get ticked when they can't get pain meds right away when they hit the floor! I have to get part of this done before pharm will allow any meds for anyone!!!!!!!

Frankly...I don't need the MD responsibilites on top of what I am already doing..and I certainly don't need a single other task or piece of paper! I am not a clerk, I am a bedside nurse thank you!

[PANurseRN1]

Another example of JCAHO running amok.

[sscathlab]

At our hospital, it is the nurse's responsibility to make sure the home medication list is as complete and accurate as possible. We then give it to the doctor to mark which ones they want to continue while in the hospital. If the doctor is not immediately available, we clarify them over the phone. but IT IS NOT OUR RESPONSIBILITY TO KNOW WHICH ONES THEY WANT TO CONTINUE. We print a med rec sheet after they are admitted and when they are discharged so the doctors can review them

Rachael

[RYNOBLASTER30]

You know, working in the ICU, these medications change so rapidly. I'm busy getting my patient settled and stabilized. I don't have time to find out why/why not the MD didn't continue certain meds. Let all of us nurses "Get Real!" We can't take responsiility for all of the physicians, they need to be responsible for themselves.

[deehaverrn]

The problem is we have all these administrator types and others for whom the RN is merely a footnote because they have so many other initials behind their names, and they are simply continuing to heap every change onto the bedside nurses already quite full back. And like the proverbial camel, we just plod on, never minding how our overburdened back is become swayed by the weight..heck, its good that we're camels so we don't have to stop and have a drink during our shift!

They give us more and more...computerized charting, (only takes a little longer but you have to wait in line sometimes for a computer terminal), forms (which only take 10 minutes more..but they don't consider that with 12 pts thats two hours), bar coded meds (trouble shooting the things that won't scan takes time, and even if it only takes a few minutes for each patient again ..it adds up). Finally med rec, sheets, on my floor (OB) the meds that they were going home on were never a problem. But these forms take soo much of our time and trouble. And does anyone else notice that even though all these things take more time...staffing is not adjusted to meet this added responsiblity. OH and to the person who asked why it is nursings responsiblity...I think its because our leaders, once they become administation, completely forget where they come from, and thats if they ever were bedside nurses-some just went right into management. Nursing really needs leaders who will stand up for us!

[Charlie77]

I have another question on this new "policy". Upon admission say the patient is unable to answer what meds they are on, there is no transfer sheet and you have to go by the H/P from the ER doc. Then you have to call the pharmicies and maybe the doc's office to add to the list. Now how accurate is all of that?

[catjolpn]

Our hospital uses the guidelines set by JACHO for med reconcilliation. If a physician fails to sign and check off on the home meds, we (nurses) call them and get the meds reconcilled over the phone and then they are required to sign forms within a specified time limit. Yes! nurses are overwhelmed most of the time but we also have a Charge Nurse on our floor who can handle this function if we are not able to at the time of admission to our floor. Most of our physicians are compliant with filling out the forms before patients are sent to us. We all need to be vigilant concerning our patients safety and well being.

We also now have the MAK system in our facility. It is one of the most relliable systems to cut down on medication errors when used properly. Even with that we need to be vigilant.

[softstorms]

I can not make any dx. Way beyond my scope. To chose a drug? WAY...WAY beyond my scope.

[MedSurgeNewbie]

We having been doing one on admit and one on discharge, I try to get the discharge ones filled out with existing meds, and put it in the chart near the discharge summry so the doc's will see it and fill it out still end up calling and getting verbals the majority of the time

[childpsychnurse]

The med recon is supposed to be an MD task-yet do any of us have doctors that actually make it a priority? Most of my admissions are VTO-with "continue whatever home meds they are on". Then, we have the client or representative that doesn't know doses OR, in the CD field, patients that are figuring out all they have to do is say they are on something and it gets "continued". We are suposed to call the MD back and get confirmation after admitting, but it doesn't correct dosage errors or clients that get sound alikes confused, too.

[Colorado1]

I have heard, more than once, contradictions in what Joint Commission requires when compared hospital-to-hospital. This leads me to believe hospitals sometimes use it as an excuse for implementation of new policies or procedures. I truly can't imagine them saying nurses need to provide the ratioale.

In our facility, the Medication Reconciliation is printed whenever a patient transfers from ICU to another floor, and the night before the patient is expected to discharge (put on front of the order section for the doc). Our printout includes both home meds (in lower case) and all those taken in the hospital (IN UPPER CASE). Then when the doc comes in he simply checks the box in the "continue" column for any he wants to carry forward. If the patient's discharging, the nurse then makes these edits to the home med list which then prints out from the system. It's a great benefit to the patients to have such a clear picture of what they're supposed to take and when.