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For members of the Texas Children's Hospital medical staff
Reconciling medications leads to patient safety
Last year, Texas Children's Hospital implemented a process to promote compliance with medication reconciliation, a Joint Commission National Patient Safety Goal (NPSG). Today, we remain vigilant in our efforts to enhance patient safety by ensuring that patient's medications are accurately and completely reconciled across the continuum of care. According to Joint Commission, organizations must:
establish a process for comparing the patient's current medications with those ordered for the patient while under the care of the organization; communicate a complete list of the patient's medications 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; and provide the patient [or caregiver] with a complete list of medications at time of discharge from the facility.
The purpose of medication reconciliation is to ensure the patient and his/her provider have a clear understanding of what medications the patient is taking and should be taking, and assure modifications throughout changes in care are reflected in further prescribing.
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By consistently performing medication reconciliation, we are following a process that will protect the patient and lead to a reduction in medication errors.
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Medication reconciliation at Texas Children's Hospital is a collaborative process with involvement between nursing, the medical staff, pharmacy, and Health Information Management (HIM). At point of entry, the Emergency Center for example, the nurse will complete the Patient Home Medication List form that captures the patient's current medications. This form is a permanent part of the medical record and will remain in the chart throughout the patient's hospitalization. As the physician or practitioner writes admission, transfer or discharge orders, he or she should review the patient's listing of home medications to determine if any of the current home medications must be continued, changed or stopped and whether at time of discharge any of these medications should be resumed.
All medication needs while the patient is in your care as an inpatient or seen in the ambulatory setting should be written as an order or as a discharge prescription, if warranted. As pharmacists do today, they will serve as a secondary safety net in the process by assessing for appropriateness of medication orders. This double check will occur by comparing the patient's home medication list to the patient's medication profile and physician orders. If needed, the pharmacist will contact the physician to resolve any concerns.
At discharge, the nurse will prepare the patient's discharge instruction
form, including a list of discharge medications, and provide this information to the patient or caregiver. Following the patient's discharge, HIM will provide a copy of the discharge instructions, including a complete list of the patient's medications, to the next provider of service. Please note: The medication reconciliation process has been delineated on the back of the Patient Home Medication List form.
As the organization maintains a state of continuous survey readiness, it will be important for all members of the health care team to speak about medication reconciliation and your role in the process. Patients are at most risk during transitions in care (handoffs) across settings, services and providers, or levels of care. Therefore, as an organization, we have taken the position that by consistently performing medication reconciliation, we are following a process that will protect the patient and lead to a reduction in medication errors.
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