I work in an approximately 20 provider clinic that has just become provider based with our hosptial. In other words, we are held to all remotely applicable hospital Joint Commission standards. We are struggling to figure out Medication Reconciliation in our clinic setting. Inpatient MedRec is pretty straightforward. Outpatient is not so much.
Currently, a nurse or MA takes or re-clarifies a written med history in our paper chart with the patient. The provider then sees the patient, and may order new meds, take them off others, or whatever. Within 48 hours the provider dictates a note for the visit, and the nurse many times doesn't see the patient after the provider. Currently, many of our providers do not dictate a full and complete list of meds after each visit. Many of our patients are not given any kind of list of their meds when they leave the clinic. Are any of you working under the same technological handicaps (no electonic medical record) and finding a way to do this that meets the standards????
All of the EMR systems we have looked at do not know what to do; the shared care plan is cool, but the medirecon.net does a great job with meds and med recon, has its own database. I consider it excellent. We are looking tohit the inpatient side with it in the coming months.
Adding to the Shared Care Plan discussion. The developers did some magic thing which we can click on a link from our EMR in the patient's record and it will take us directly to the individual patient's Shared Care Plan (if they have/maintain one). I have one myself.
Another useful tool in the SCP is the ability to import/scan the actual legal document pertaining to Advanced Directives, POLST, etc. That way there is never the problem of finding the paper chart for such orders.
So our Med Recon efforts continue. Our med list accuracy rate confirmed by audits of 120 charts in November was the highest ever at 95%! Yay. All the work pays off. The key is to make whatever process you adopt, universal to all persons touching the med list (nurse, PCP, hospital, etc.) and to do it right every time. After almost 2 years now, we have maintained the process as an accepted "thing we do now" and the med list accuracy rate has risen from 69% (before any formal Med Recon was done), to a steady 93-95% accuracy rate. It works if everyone does it every time with every patient.
What are you all talking about? I don't mean to sound stupid, but I have no idea what "medication reconciliation" is, or what EMR is. Is there something I need to know? obviously! I work in an outpatient mental health clinic.
Medication Reconciliation is the tortured attempt to record the medications a patient is taking. Patients assume the doc knows what meds they are taking, Docs assume the patients know... Sometimes neither party knows. So it is the laborious process of asking the patient what meds (OTCs and supplements included) they are taking, when, what dose, etc.
JCAHO considers the following a discrepancy:
med that the patient is taking that is NOT on the Provider's med list, or
med that IS in the list which the patient is not taking.
For our office purposes, we also include dose differences as discrepancies, "Oh, I actually only take half a pill of Coreg because it is so expensive", when they were prescribed a whole pill.
It is a fluid and ever changing process as patients are the ones who are truly in charge of what meds go into their body (which may or may not be as prescribed). It improves safety for the patient if all healthcare providers are made aware of this information.
mkhaneja
6 Posts
All of the EMR systems we have looked at do not know what to do; the shared care plan is cool, but the medirecon.net does a great job with meds and med recon, has its own database. I consider it excellent. We are looking tohit the inpatient side with it in the coming months.
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