New process for reconciling patient medications will start at the point of entry and end at discharge - Progress notes


June/July 2006 In this issue
Patient safety and family involvement in hospital care are important themes
Join me in welcoming our new residents and fellows
The way that Neurology research outcomes are evaluated poses challenge in progression from bench to bedside
New process for reconciling patient medications will start at the point of entry and end at discharge
Research Administration serves as advocate for all researchers
Care Management Services ensures smooth patient flow and continuum planning
Family Advisory Board provides valuable input

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For members of the Texas Children's Hospital medical staff

New process for reconciling patient medications
will start at the point of entry and end at discharge

Effective June 21, Texas Children's Hospital will implement a medication reconciliation process to promote compliance with the Joint Commission’s National Patient Safety Goal (NPSG) # 8 and to reduce medication events. According to JCAHO, chart reviews disclose more than half of all medication errors occur at the interfaces of care. A study of pediatric cancer patients revealed variances between the information from patient/guardian regarding the medications patients were taking prior to admission and their medication orders to be 30 percent. In addition, the Institute for Healthcare Improvement (IHI) reports that reconciling medications may help to avoid as many as 50 percent of all medication errors and up to 20 percent of adverse drug events.

Medication events that can be prevented include:

Inadvertent omission of needed pre-admission medications
Failure to restart pre-admission medications following transfer and discharge
Duplicate therapy at discharge
Errors of incorrect doses or dosage forms

The goal reads:

Accurately and completely reconcile medications across the continuum of care.

Implement a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization and with the involvement of the patient.
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.


	View full size pdf.

By using a form to capture the patient’s current home medications, Texas Children's Hospital will implement a collaborative process between nursing and the medical staff to meet the intent of the NPSG. This form will be completed by the registered nurse at the point of entry, i.e., the Emergency Center, and remain in the medical record under the new tab "Patient Home Med List." As the physician or practitioner writes admission orders, he or she must review the patient’s listing of home medications for the potential for drug interactions and determine which, if any, medications should be continued. If medications are to be continued, they should be written for as part of the admission order set.

Also, at time of discharge, the physician or practitioner must review the patient’s listing of home medications and the current inpatient medications to determine which, if any, medications should be resumed or continued. Once this is determined, any post-discharge medications needs should be included in the discharge instructions and prescriptions provided. This action will complete the physician and practitioner’s responsibility for medication reconciliation.

According to the Joint Commission’s frequently asked questions on this particular NPSG, it is usually not necessary to reconcile against the original list of home medications for internal transfers, change in level of care, etc. However, for changes to a less intensive level of care, it might be useful to review the home medication list to see if some medications that were not continued on admission should be resumed now that the patient is at a lower level of care.

In collaboration with Health Information Management, the process of communicating a complete list of the patient’s medications directly to the next provider of service is currently being developed.

Should a Joint Commission surveyor question a member of the health care team about medication reconciliation, it will be important that both nursing and the medical staff are able to speak to the process as it occurs at Texas Children's Hospital.

To read more about medication reconciliation, visit the Joint Commission’s Web site.