“One of America’s Best Hospitals” – U.S. News & World Report Medication Medication Reconciliation Reconciliation JCAHO Patient safety Goal #8
Jan 04, 2016
“One of America’s Best Hospitals” – U.S. News & World Report
Medication ReconciliationMedication Reconciliation
JCAHO Patient safety
Goal #8
MandateMandate To improve patient safety and provide consistent
care, a medication reconciliation process incorporating a patient’s “home medications” must be implemented and in place January 2006
This is a Regulatory Requirement
Based on recorded sentinel events
“One of America’s Best Hospitals” – U.S. News & World Report
DefinitionDefinitionA formal process of identifying the most
accurate list of all medications a patient is taking, and using this list to provide correct medications for patients anywhere within the health care system
Requires comparing the patient’s list of current medications (home meds) against the physician’s admission, transfer, and discharge orders
“One of America’s Best Hospitals” – U.S. News & World Report
IHI
One of the six proven interventions to save lives:
Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation
“One of America’s Best Hospitals” – U.S. News & World Report
Preventing ErrorsPreventing Errors• Inadvertent omission of needed home
medications
• Failure to restart home medications
• Duplicate therapy (the result of brand/generic combinations or formulary substitutions)
• Orders with incorrect doses or dosage forms
• Physician orders include “meds as at home”
Approved by Med. Exec.Approved by Med. Exec.Approved by Med. Exec.Approved by Med. Exec.“Attending” physician must be responsible for
medication reconciliation at time of admission, transfer and discharge
One - “Captain of the Ship”*
Eliminate all physician order such as:• Resume home meds
• Resume pre-procedure orders
• Resume pre-op orders—already approved by MEC
*Surgeon will review post op and intensivist may review on transfer to ICU
When Medication When Medication Reconciliation is RequiredReconciliation is Required
When Medication When Medication Reconciliation is RequiredReconciliation is Required– Admission: Screen review and formal
acknowledgement– OR: DC/Cancel function and formal
acknowledgement (approved by MEC)– ICU: Screen review and formal
communication (approved by MEC)– Discharge: Paper form (similar to the 3008
form currently in use for ECF)
Physician’s RolePhysician’s RolePhysician’s RolePhysician’s Role• Review home meds list at the time of admission, transfer, or
discharge• Enter a reconciliation communication in SCM acknowledging
that the patient’s home medication list has been reviewed on admission and transfer
• Complete Medication Reconciliation Report from SCM at discharge with list of home and active pharmacy orders indicating “continue” or “discontinue” at home
• The “Attending” physician is ultimately responsible for medication reconciliation – “the Captain of the Ship”
• It is the responsibility of the “Attending” physician to communicate with consulting physicians to clarify medication orders
Choose Medication Reconciliation from the Clinical Summary Tab
Choose “Medication Reconciliation
Communication”
*
A mandatory field must be completed.
When the “attending” physician logs onto the chart, an alert will
be triggered interrupting the order session if a reconciliation
communication has not been placed in the chart
This is the alert to direct
the “attending” to use the “View
Actions”
The “attending” should click on “keep this order” (indicating the
Chem 7 in the example).
Next, the “attending” should click on
“Actions”
The Medication Reconciliation Communication Order field will be
visible and mandatory.
Once the attestation is complete, the “attending” physician should
click OK
The order entry window will appear and orders can be submitted as usual.
“Attending” will indicate which medications are to be
continued or discontinued by checking in the appropriate
column
This form is printed on discharge. From the orders tab in SCM, click on the printer icon and choose Medication
Reconciliation Report
Nursing will use this list to complete the patient discharge Instruction
form completing the reconciliation process
Bottom half of Reconciliation Form