Jcaho Medication Reconciliation

Nurses Medications

Published

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????

Specializes in Psychiatric NP.
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 facility, we write in the medications on the reconciliation form and the doctors check whether to continue the med or not on admission, on discharge they check on the same form whether or not to continue the medicine. However, they do not offer a rationale in writing as to the reason for continueing or D/Cing the med, the only way to find out is to ask the doctor or go through the progress notes(assuming they wrote down the reason) We are just responsible for making sure the doctors don't forget to do it

Up Vote Up Vote ×
Specializes in ER/Trauma.
At our facility, we write in the medications on the reconciliation form and the doctors check whether to continue the med or not on admission, on discharge they check on the same form whether or not to continue the medicine. However, they do not offer a rationale in writing as to the reason for continueing or D/Cing the med, the only way to find out is to ask the doctor or go through the progress notes(assuming they wrote down the reason) We are just responsible for making sure the doctors don't forget to do it
Ditto here... and what a job it is in getting them to do it.

Some of them don't even look at the damned thing - they just check "Continue" on all of them.... even if they are IV meds and the patient is being discharged :trout: !

The surgeons are the worst!

Up Vote Up Vote ×

We have been doing this for awhile. We came up with our medication reconciliation form. It gets started in the ER. The nurse writes the patient's home meds, the doctor goes over each and checks continue, hold or d/c, then on admit he will order meds as reconciliation. The nurse then has to write all meds out on order sheet. Upon discharge the nurse writes any new meds on this same form, the doctor goes over it and marks the ones he wants them to be on at discharge. It has worked out pritty good for us.

Creature

Up Vote Up Vote ×

I work on an ortho/neuro unit where the doctors are babied. Our med reconciliation forms used to be order sheets that the doctors could check mark DC or continue but none of them used the order form the right way. So now the med rec form is put in the progress notes for review and then the doctor is supposed to write an order for which meds to start. The hospitalists and internal med docs are usually pretty good about writing out which meds to start but the darn ortho/neuro docs will write, "Continue home meds." Well we can't write out a clarification order and list the meds as listed on the med rec form so we must then call the doctor and read the list to them and get approval for each med. Half the time these guys don't even know what the medication is!! Then we have to listen to them ranting and raving about being paged blah, blah, blah. Then when the pt is discharged we have to do the same thing all over again and write out all of the meds to be DC'd on. It is a lot of work and is really frustrating.

Up Vote Up Vote ×

Hi everyone...we have been having to do med recon's in our ER for about the last 4-5 months. It has been getting easier...all we (as nurses) are responsible for is printing their med recon sheet (since I work for an HMO the patient's meds will print out as long they get them filled at one of our pharmacies), and then we are to go through the list with the pt and just list "taking or not taking" we don't have to put the last dose, how much etc...and we are suppose to list any herbals or OTC's. At that point prior to going home the ER doc or admission doc (if they went up to floor) are suppose to reconcile it and the pt gets a new sheet on discharge telling them what new meds they have, what to cont to take, and what to d/c. But we in no way are responsible for a "doctor's rationale". I have been told that JACHO likes the way we do it....

Up Vote Up Vote ×
Specializes in neuro,renal,tele.

We are in Mechanicsville, VA and we are responsible on admission for filling out the med rec form and scanning it to pharmacy. We are supposed to write down the time and date that each med was last taken and circle yes if the MD ordered it on admission and No if he didn't. We are supposed to sign under a statement that says we have consulted the MD reconciling the meds (i.e. regarding omitted meds). We have been told that we can put lines through that statement. But I totally agree with you that it's the MDs job to get an accurate list of home meds. Besides, who is going to call an md at 0300 for a home colace, vitamin or other such non-urgent med???

Up Vote Up Vote ×
Specializes in TraumaER ,NICUx2days, HEMEONC CathLab IV.
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????

#1 i would dare any jacho monkey and i am afraid i am insulting the monkey here, to follow and keep up, while taking care of the volume of patients we do in the er, and then some how add time to my already insane day to chart a med recon page, patients now have 8-18 meds. ,ie: "a bp med and sumthin for my gout" 30% of the md's look at the sheet and if they wanted to know they could go ask while they are doing their history and physical for god's sake. that is a run on sentence folks.......but it is 0400, and insonmnia and i are up ranting now,

#2 were are our kahaunas?? when are we going to say, no, nay nay, no way, not gonna do it..... as a collective group?????

nurses are woosies as a group i know i have been one for 30 years,seen 'em, yelled and screamed, jumped up and down, we are sooooo passive aggressive it makes me, well crazy..... in the er most patients don't recall medication name time last taken or dose, and i am happy to write that down. i spoon feed my children i should not have to spoon feed a 34-70 year old doctor. if we all do it maybe they will get the message and leave us to do what we are trained to do and do best, patient care

this is not what florence intended.....

a side note....,

pharmacy wrote me up for writing down a dose of a drug as

84 mg, what the patient had written down on his "drug list"

so it went like this "bigpillaguss, 84 mg. po daily "

the pharmacy said bigpillaguss is 8.4 mg not 84 mg, i said, you write down the meds then, b/c that is what is written on the patients "list".and, btw where is my heparin drip and insulin drip you are suppose to mix,,,, since i am too inept to mix my own in the er now..i am waiting....... when i write any med recon list i add .....this list may not be accurate to drug name, dose, time last taken, check with patient

and yes i am shouting......

Up Vote Up Vote ×
Specializes in Med surg, Critical Care, LTC.

I disagree, it is a MD's problem to get med reconciliation AND the nurses responsibility. Come on guys (gals) think about all the mistake Doc's make, do you want to depend on their assessment alone?

How many patients do we have that go to the PCP, the Cardiologist, the pain clinic, the urologist, etc... how can we be sure that the list of meds the admitting PCP has is correct? Might it be possible that the PCP hasn't been notified of a new med one of the other doc's put the patient on?

That's is where we come in. We ask for a complete list, add and delete meds accordingly, and then it is up to the PCP to take it from there.

It's part of the admissions assessment, the preoperative assessment, and it's here to stay if you want to be JACHO accredited. And it makes sense! Too many errors were being made.

Sometimes it's just best to go with the flow, we have more important nursing issues to talk about. That's my :twocents: worth.

God bless

Up Vote Up Vote ×
Specializes in Tele; Med/Surg; ED.

We do the med-rec - but rationale?? Where did that come from? Just another form of pencil-pushing that takes away from real patient care. Ridiculous!

Up Vote Up Vote ×
Specializes in Med surg, Critical Care, LTC.

Suggestion for 10mgIV: photocopy the patients med list that they give you from now on, and place it with the chart. That's what I've started doing. It many help to avoid a problem in the future. Just a suggestion

Up Vote Up Vote ×

OMG- yet another reason this field is so embarrasing.

Up Vote Up Vote ×
Specializes in Utilization Management.
We do the med-rec - but rationale?? Where did that come from? Just another form of pencil-pushing that takes away from real patient care. Ridiculous!

Wouldn't the rationale to be to get the patient the correct meds based on what they were taking at home?

I mean, if you had no idea of what the patient took, how could you know enough to do a Dig level or whatever? And then, all the meds get changed and the patient is sent home, to do what? Continue the home meds and add the new ones?

At least with the Med Rec forms, it's pretty clearly spelled out to help the patient understand what he's taking, what he's not, when, and what for.

To me, that IS a big part of patient care. :confused:

Up Vote Up Vote ×
+ Add a Comment