The same systematic review found that electronic tools often lacked the functionality to accurately reconcile medications, perhaps explaining why medication discrepancies persist even in organizations with fully integrated electronic medical records. Several studies have also investigated the role of enhanced patient engagement in medication reconciliation in the outpatient setting and after hospital discharge. These efforts are promising but also lack evidence regarding the impact on medication error rates.
Medication reconciliation has therefore become an example of a safety intervention that has been effective in research settings but has been difficult to implement successfully in general practice.
A commentary identified the major reasons for difficulty achieving safety improvements via medication reconciliation. They include the resource intensive nature of interventions such as clinical pharmacists, which disincentivizes organizations from investing in medication reconciliation; the alterations to clinical workflow that result from interventions, which creates inefficiencies and confusion regarding the best possible medication history; and conflict between medication reconciliation and other system quality improvement priorities, such as patient flow improvement.
The commentary provides recommendations for organizations, clinicians, and researchers on how to better implement and evaluate medication reconciliation interventions. The Joint Commission's announcement called on organizations to "accurately and completely reconcile medications across the continuum of care.
The Joint Commission suspended scoring of medication reconciliation during on-site accreditation surveys between and This policy change was made in recognition of the lack of proven strategies for accomplishing medication reconciliation. As of July , medication reconciliation has been incorporated into National Patient Safety Goal 3, "Improving the safety of using medications. To sign up for updates or to access your subscriber preferences, please enter your email address below.
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Recommended Resources. Step-by-step instructions for reviewing closed patient records to identify errors related to unreconciled medications. A tool for tracking data during a test of medication reconciliation during admission. Join NursingCenter to get uninterrupted access to this Article. During , healthcare organizations were to develop a process for obtaining and documenting a complete list of patients' current medication upon admission. However, in discussing this National Patient Safety Goal NPSG during periodic performance review conference calls, it's apparent that medication reconciliation continues to be a challenge for many healthcare organizations.
NPSG 8 was formed to accurately and completely reconcile medications across the continuum of care. Part of this goal, specifically 8A, affirms that there's a process for comparing the patient's current medications with those ordered for the patient while under the care of the organization. The other part, 8B, states that a complete list of the patient's medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner, or level of care within or outside the organization.
The complete list of medications is also provided to the patient upon discharge from the facility. Development of a medication reconciliation form to be used as a template for gathering information about current medications can be used to standardize care and prevent errors. As part of the medication reconciliation process, you should always note all discrepancies, which The Joint Commission defines as omissions, duplications, contraindications, unclear information, and changes.
This is an essential step for any successful medication reconciliation protocol. In most electronic health records EHRs , medication reconciliation information is documented in a list format, so that all medications can be reviewed in one place by the next provider who meets with the patient.
Whenever you make a change to a patient's regimen following an encounter, take the time to explain the reason s for the change, cover any new information about frequency and route, and provide a summary of this information in writing to the patient and any accompanying family members. Be sure patients understand that any new over-the-counter medications and supplements should be added to the list and communicated to the primary care physician during their next visit.
Looking for more information that can help you strengthen your medication reconciliation procedures and performance? Consider checking out this blog , which outlines med rec steps you should take during every transition of care, and this blog , which further explains why medication reconciliation remains such a substantial challenge for organizations and providers despite the fact that medication reconciliation has long been recognized as a critical patient safety process.
Medication Reconciliation. Medication Management. Cureatr News.
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