?'s about Med Rec

[sundowners2]

Hello all, I have some quick questions about med rec:

I haven't been a RN for long, but I've admitted enough ICU pt.'s who came in through the ER to notice that medication reconciliation is a process with which hospitals struggle. Several times I have seen the scenario play out where a pt. has been in the hospital 2,3,4 days before we realize that they were on lithium/dilantin/lasix/[insert important med here] at home and it has not been continued in the hospital. It's not hard to imagine how failing to reconcile meds like dilantin can and has caused major adverse events and lengthened the pt.'s LOS in the hospital. So, from an inexperienced RN who has never worked ED, here are some questions:

How do we reconcile meds for patient's who come in with CVA's or some other mental status change? How do we get home meds from pt.'s who are poor historians?

How can we be sure that the PMH that the pt. reports is 100% accurate?

What's to stop a pt. from saying that he/she has chronic back pain and takes scheduled morphine at home? In other words, how do we know a pt. isn't just making these dx's and meds up?

Many pt.'s go to multiple docs and multiple pharmacies. So, basically, what I'm wondering is how do we verify the accuracy of these so-called prescribed meds.?

Thanks,

JP

[RNsRWe, ASN, RN]

You do the best you can. Most people who are poor historians have a caregiver, family member, someone who can give more accurate information. It's pretty common to admit a patient who has no clue what they take ("I get a yellow pill in the morning. Sometimes."). But usually there's someone who is either with them at admission or can be contacted to provide more details.

As for the patient who claims chronic MS use and you doubt it's veracity, you can always ask for the prescribing physician. Providing a recent pill bottle is helpful. If we get someone who makes such a claim and the presentation doesn't support it, they aren't likely to get it until the attending physician decides to prescribe it himself (or herself).

You're never going to be SURE that what you're told is 100% accurate, unless you have a longer history of the patient to work with, or their own physician is on your staff (or a frequent admitter, so you see them often). You just do the best you can.

[HouTx, BSN, MSN, EdD]

This is certainly a HUGE problem that has received National attention. If you're interested, there's even a stream of medical informatics research on med reconciliation - including big grant funding from AHRQ.

There is nothing we can do about patients that won't or can't provide information - but we can take the time to do med rec with the information at hand.

We would all welcome a truly effective automated system to prevent these sorts of problems - but until it happens (maybe about the same time we all get to drive those flying cars we were supposed to have by now) Nurses will be the gurardians at the bedside.

[classicdame, MSN, EdD]

ask who prescribes and what pharmacy they use - that helps a little. Family can help (and hinder). Overall, we just do the best we can and then hope for the best.

But, as an example, I cared for an elderly guy who was taking Lasix from Dr. A and Furosomide from Dr. B. No wonder he was dehydrated!

[StarlightRN]

I think medication reconciliation is a problem everywhere. I don't work in the ED, but on the floor. If the patient can't tell us, or even the family can't we can always call the pharmacy they use and get a list. Of course that doesn't take care of meds they might have at multiple pharmacies. That's where teaching comes in to the patient. That it is very important to only use one pharmacy. As far as a patient saying they take morphine for chronic pain, when they really don't, the doctor is the one that decides if they believe it to be true and okay that order. I just love it when they come in with a list of exactly what they take, how much and how often. It's makes the process so much easier. But we just have to do the best we can with what we have and hope that it's correct and accurate.

We had a patient bring in her medication bottles from home and the nurse opened up the bottle and it had a small bag of marijuana in it. We were shocked.

[SillyStudent, ASN, RN]

But, as an example, I cared for an elderly guy who was taking Lasix from Dr. A and Furosomide from Dr. B. No wonder he was dehydrated!

Poor guy probably had a K of 2