Medication Reconciliation Are all hospitals doing this?

[GardenDove]

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 anyone seen some concrete positives come out of it. There've been some problems where I work. The nurses are hurrying to get the forms done, some of the docs are blindly signing them off. I notice it's a bigger problem when the admiting doc is not the primary doc for the pt. Also, some of the older pts are tinkering with their prescribed doses at home, they give us the info, we write it on the med-rec sheet, the admit doc takes it as the gospel, and then there is an error. I had a pt who ended up being over metropolized on a double dose which he had also been mistakenly taking at home. He was having some pretty significant non sustained bradycardia, and when I called the primary he said that the dosages, which had been taken off of med-rec by pharmacy, and had been incorrect.

My point being that med-rec is sometimes creating more problems than it's solving. Also it's timeconsuming. I haven't given up on it yet, but I'm losing hope.

[Antikigirl, ASN, RN]

I 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!

[Antikigirl, ASN, RN]

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!

[GardenDove]

k3 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.

you know, that might be the crux of the matter. And, it seems like pts, pharmacy, and docs like to pawn everything off on the nurses. Also, why can't pts take responsiblity for their own healthcare? I'm glad, at least, my hospital did a big local radio campaign when they rolled this new program out a few months ago. They also tried to collaborate with all the local pharmacies and doctors' offices, and had a manditory inservice for the docs.

I think it is well intended, but has an awful lot of flaws which will never be solved due to the fact that you are dealing with the public, and there are alot of flakey people, plus older folks who really need assisted living.

[HappyNurse2005, RN]

We do it.

[shiloh11]

We do this form on all pts now. For every pt type the form gets scanned to pharmacy and then is placed in the chart. 99% of the time the doctor still ends up writing whatever meds they want in their orders. They arent using the forms at all. To make matters worse, I work in Out Patient Procedures where we do same day procedures, conscious sedation, and infusions. They are now telling us they want us to initiate the form EVERY time the pt comes in. We have people that come 2x/day for up to 3 months at a time. Its absolutely ridiculous to be doing a form that no one is looking at over and over.

To make matters worse they've now added a form called Out Patient Summary flow sheet in which we are supposed to write each day if the patient has had any changes (ie: new health problems, medication changes, illnesses etc). Of course we are already writing the changes and any interventions we make in the nursing notes. I swear the people making up these forms dont ever have to actually use them. Do any of you guys have to do this too?

A new outpt Lovenox patient ends up taking 30 minutes because of all the paperwork. Its nuts!!

[luckylucyrn]

Unfortunately we have do do this on EVERY ER patient, no matter if they are going to be admitted or not. This means that we fill it out on grandma with 3 pages of meds in the ER for a minor problem. sometimes it takes FOREVER!

[rnin02]

k3 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.

That's exactly what I think! Competent patients (ie, not the ones with dementia, developmental issues, children) need to be responsible for their health! Nurses and doctors should be responsible for education while in the hospital, making sure the patient understands their Rx's when they are discharged (or after an MD appt), but the patient is the only one who knows which MDs they have seen, what meds they have been prescribed, and they have the ultimate responsibility to keep an accurate list and communicate that list. Those med recs drive me crazy! In our hospital we have to complete a med rec within 24 hours, plus all meds that are to be continued are to be written out on an order sheet, pharmacy doesn't use the med rec form for continuing meds.

[perfectbluebuildings, BSN, RN]

We have this but it is probably easier b/c it's a peds hospital so most kids don't have many meds, and the ones who do, have chronic issues and their parents are typically on top of it with a VERY specific list. The doctors and us grumbled at first but now I like them. There's a spot for each med to check "order, do not order, or new". And our doctors almost ALWAYS fill them out themselves and we go over them during the admit process with the parents to make sure nothing was missed. It started out really tedious and we hated it but now the impractical kinks have smoothed out under everyday use and it's actually a lot easier all around.

Some of the doctors, like the pulm. doctors that admit CF pts all the time who are on so many meds, will write on that med.rec. sheet See Standing Orders b/c they have a protocol order sheet they've written out themselves with the "typical" CF meds and that works out and pharmacy does not have a problem.

We have to print one if the kid's going to surgery or to the ICU as well, with all current meds, and the doctors seem to like them b/c everything's in one place for continuing or not at that point and there's space to add new meds if needed.

However, it sounds completely different in the adult world. I sympathize with you and it is one more reason for me to stick with the kids (not that I really needed any...)

[Nursonegreat]

anyone out there that works in an ambulatory surgery center and doing these??

[caroladybelle, BSN, RN]

I believe that it is a JCAHO requirement....coming to a facility near you, soon.

[Nursonegreat]

i was told by my NM that it isnt a REQUIREMENT yet but soon will be in the future, so we made up our own form and have started using it. PITA. anyone from ambulatory surgery using these yet??