Med reconciliation

FolksBtrippin, BSN, RN · Apr 26, 2019

Errors happen and this does not sound like a big one. Doubling up on seroquel is likely just going to make a person extra sleepy. Seroquel has a wide dosing range, and there could be many reasons this mistake happened, including other people's errors. With psych meds, often there is a discrepancy between what the psychiatrist ordered and what the PCP ordered. The hospitalist is ultimately responsible for ordering the meds, so you aren't the only line of defense. It's good that you're taking responsibility, and this is a hallmark of a good nurse, but dont take too much responsibility. Working in a hospital, you might spend all your time looking at the underside of a bus unless you are willing to pushback when you need to.

That having been said, if you want to tighten up your med rec, let's talk about how to do a tight med rec. I apologize in advance if you already know this stuff. I worked with many nurses who didn't know anything about how to do a med rec, and not everyone has been taught, so I think it's worth going over.

Remember that a nurse's med rec is about recording what the patient is actually taking even when that does not match what the patient has been prescribed.

Find out what pharmacy the patient uses at home and call. Get a rundown of what has been filled. Patients can't take meds they never pick up from the pharmacy.

Check the meds that have been filled against the patients report on what they take.

Example: Are you still taking seroquel 100 mg 2x a day? "I skip the morning dose because I get too sleepy." Do you always skip the morning dose or just sometimes? "Always." This could also be reflected in the pharmacists report, that the med was last picked up 2 months ago instead of 1 month ago. In this case you are inputting seroquel 100 mg daily, not BID. If the patient is taking less than the prescribed dose or more, add a comment in your med rec to reflect that. Use quotation marks if the info came straight from the patient.

Double check that you are inputting the frequency data correctly into your system. This was often a problem at my last workplace.

TriciaJ, RN · Apr 26, 2019

I always found med reconciliations to be a complete PIA. Many patients don't even have any idea what they're actually taking ("I don't know; the wife takes care of that"; "I can't remember the name; all I know is it's the little white one".

It's a very time-consuming and often convoluted process. Which is why I'm saying don't beat yourself up too much. It's a good thing you're conscientious and take this seriously, but you can only do so much.

beekee · Apr 26, 2019

Once I get responses like “is that the red one?” or “my son sets them up for me,” I give up and put in a pharmacy consult. Anything I do is going to be wrong anyway.

Med rec is always a cluster. No one ever knows and the list in the computer is 20+ meds long.

I wouldn’t sweat it too much. Unfortunately, the home med lists are probably more often wrong than they are right.

schoolforever · Apr 26, 2019

Yes, I feel like no one either does them or they aren't accurate due to cross-viewing the computer orders, verbal discrepancies, and piece of paper from 1953. I also feel bitter like it isn't in my scope of practice. "Why am I changing your prescriptions?!"

I really am conscientious when giving all my meds so I'm glad I'm not the only person with issues.

Thank you guys for all your support and tips. I'm going to talk to my teacher about it tomorrow to see if she has any further advice for me. If anyone has anything else they'd like to share I welcome it. I plan to put in pharmacy consults in the future (I never even thought of that ?). I feel a lot better.

JKL33 · Apr 26, 2019

Okay. This is most certainly not something to make anyone question the meaning of life or the future or anything else.

3 hours ago, TriciaJ said:
It's a very time-consuming and often convoluted process.

Yep. I have remotely no idea why they would even talk to a student about this, rather than just ask the preceptor to review it and/or to perform the next MR together with the student. ? ?

My guess is that the med had populated the list more than once and you confirmed both entries?

Editorial Team / Moderator · Apr 26, 2019

Admitting physician should have caught this long before it reached the patient, no to mention the nursing staff who gave it. Sheesh.

JKL33 · Apr 26, 2019

I don't think the patient actually did get a double dose.

It sounds like the patient had an ED visit after an admission and entries for the same med from a home list and an internal list were both confirmed. Now the patient has gone back to the GP, who has misunderstood and thought the pt was receiving a double dose while hospitalized.

(?)

Editorial Team / Moderator · Apr 26, 2019

1 minute ago, JKL33 said:
I don't think the patient actually did get a double dose.
It sounds like the patient had an ED visit after an admission and entries for the same med from a home list and an internal list were both confirmed. Now the patient has gone back to the GP, who has misunderstood and thought the pt was receiving a double dose while hospitalized.
(?)

Ahhhhhhh. Thanks, I re-read. ?

Guest219794 · Apr 27, 2019

Don't sweat this.

You may or may not have made a mistake, but whoever assigned a student to do a med rec seems to have made a mistake.

Is that really a thing- having students reconcile medications?

schoolforever · Apr 27, 2019

I left out that my preceptor looked it over

Glycerine82, LPN · Apr 27, 2019

Best thing to do is have another nurse double check your work and try to get two lists to compare.

I just made a transcription error with tylenol of all things. It only got caught because the family got upset.....long story, but it happens!