Who is responsible for medication reconciliation?
To design a robust medication reconciliation process, first define steps involved and decide who should be responsible for each step. A reliable medication reconciliation system requires a multidisciplinary approach, often with the participation of physicians, nurses, and pharmacists across the continuum of care.
What are the steps in medication reconciliation?
The Process
- Obtaining the Patient List of Medications One of the first questions you ask a patient when they come to a healthcare facility is for the list of medications ...
- Developing the Prescribed List of Medications Medical practitioners are responsible for prescribing the medications they want the patients under their care to take. ...
- Comparing Both Lists
Who can perform medication reconciliation?
medication reconciliation performed by pharmacists, pharmacy learners, and pharmacy technicians in the outpatient setting. Thorough medication reconciliation can improve patient safety by identifying and reconciling discrepancies. This document can assist pharmacists in
What are the benefits of medication reconciliation?
· Medication Reconciliation – will provide education if not proficient. · Other: Use of usual and customary equipment used to perform essential functions of the position. Work may occasionally require travel to other UPH facilities. May drive a UPH vehicle, rental or own vehicle.
Is medication reconciliation required?
It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care.
Who mandates medication reconciliation?
The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation. The EP performs medication reconciliation for more than 50 percent of transitions of care in which the patient is transitioned into the care of the EP.
Does CMS requirements medication reconciliation?
Effective care coordination efforts, CMS goes on to state, must include medication reconciliation post-discharge.
What is the role of the Joint Commission in medication regulation?
The Joint Commission requires organizations to identify, in writing, high-alert and hazardous medications available and follow a process for managing such medication.
What is the difference between medication review and medication reconciliation?
The Institute for Safe Medication Practices Canada (ISMP) states that: “Medication reconciliation is intended to prevent medication errors at transition points in patient care, whereas medication review is intended to address drug-related problems arising over time.”
When should a nurse perform medication reconciliation?
Medication reconciliation can be considered complete when each drug the patient is taking has been actively continued, discontinued, held, or modified at each transition point”. Transitions in care include changes in setting, service, practitioner or level of care (IHI, 2015).
When Should medicines reconciliation be completed?
GPs should undertake medicines reconciliation within 1 week, and should not issue new prescriptions or supplies of medicines before medicines reconciliation is complete. General practices may also liaise with community pharmacies about any medicines discharge information the pharmacies receive.
What is medication reconciliation and when should it be done?
Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician's admission, transfer, and/or discharge orders, with the goal of providing correct medications ...
How do you bill for medication reconciliation?
Note: CPT® II code 1111F can be billed once per discharge. Medication Reconciliation does not require a visit with the member, but documentation must be in the outpatient medical record.
What are the 4 key principles of The Joint Commission?
You must treat all customers, fellow employees and contracted third parties with respect, honesty, fairness and integrity. Never compromise integrity for a quick solution. The principle of business ethics incorporates The Joint Commission values of integrity and respect as a core elements of our corporate culture.
What are The Joint Commission requirements for medical records?
For organizations that use Joint Commission accreditation for deemed status purposes, CMS requires that the medical record contain information to justify admission and continued care, support the diagnosis, describe the patient's progress and response to medications and services.
What is the difference between CMS and Joint Commission?
CMS has been designated as the organization responsible for certification of hospitals, deeming them certified and meeting established standards. The Joint Commission sets its standards and establishes elements of performance based on the CMS standards.
Who are the key players in the medication reconciliation process what are their roles?
The medication reconciliation process is a shared responsibility of healthcare providers in collaboration with patients and families. It requires a team approach including nurses, pharmacists, physicians and other healthcare providers.
What is the nurses role in the medication reconciliation process?
Nurses considered themselves to be second only to physicians in medication reconciliation since they: obtain an accurate medication history on admission, verify and reconcile discrepancies between the medication history list, those ordered on admission and at transition, and send the discharge medication list to the ...
What role can a pharmacy technician play in medication reconciliation?
Data Synthesis: Pharmacy technicians can help pharmacists perform medication reconciliation by taking on 3 specific roles in the process: obtaining preadmission medication history, obtaining relevant patient information from outpatient pharmacies and health care providers, and documenting the compiled medication list.
Can social workers do medication reconciliation?
The social worker focused on traditional transition issues, such as ensuring follow-up with primary care physician and performing medication reconciliation, and also worked with Mrs. S to identify and address other health-related needs, such as improved pain management and increased access to supportive services.
Why is medication reconciliation important?
Medication reconciliation is a major component of safe patient care in any environment.
What factors contribute to a lack of a complete medication reconciliation?
A multitude of factors—such as patients’ lack of knowledge of their medications, physician and nurse workflows, and lack of integration of patient health records across the continuum of care —all contribute to a lack of a complete medication reconciliation, which in turn creates the potential for error.
How to reconcile medication history?
The steps in medication reconciliation are seemingly straightforward.7For a newly hospitalized patient, the steps include obtaining and verifying the patient’s medication history, documenting the patient’s medication history, writing orders for the hospital medication regimen, and creating a medication administration record. At discharge, the steps include determining the postdischarge medication regimen, developing discharge instructions for the patient for home medications, educating the patient, and transmitting the medication list to the followup physician. For patients in ambulatory settings, the main steps include documenting a complete list of the current medications and then updating the list whenever medications are added or changed.
What are the discrepancies in medication order?
Among the most common medication discrepancies between what is in the patient’s history and what is ordered upon admission to the hospital was omission of a medication that patients reported taking prior to admission.13These discrepancies result from incomplete documentation of the patient’s medication history and a lack of time to search for the information. Nursing staff have been noted spending in excess of an hour per patient admission or transfer trying to accurately identify medications a patient has been receiving,3including getting a list of preadmission medications from the patient and filling in gaps through the pharmacy and primary care physician.
What percentage of medication orders need to be changed in the ICU?
Examining discrepancies between medications a patient was receiving in the ICU and the discharge orders from the surgical ICU resulted in 94 percent of discharge orders needing to be changed. Following implementation of a paper-based medication tracking system, the error rate of discharge medication orders was reduced to zero.20Following implementation of a reconciliation process using an electronic form at discharge from a surgical ICU, only 21 percent of orders required changing.
What is included in a medication list?
A comprehensive list of medications should include all prescription medications, herbals, vitamins, nutritional supplements, over-the-counter drugs, vaccines, diagnostic and contrast agents, radioactive medications, parenteral nutrition, blood derivatives, and intravenous solutions ( hereafter referred to collectively as medications).6Over-the-counter drugs and dietary supplements are not currently considered by many clinicians to be medications, and thus are often not included in the medication record. As interactions can occur between prescribed medication, over-the-counter medications, or dietary supplements, all medications and supplements should be part of a patient’s medication history and included in the reconciliation process.
How many medication errors are there in a hospital?
According to the Institute of Medicine’s Preventing Medication Errorsreport,1the average hospitalized patient is subject to at least one medication error per day. This confirms previous research findings that medication errors represent the most common patient safety error.2More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients.3Of these errors, about 20 percent are believed to result in harm.3, 4Many of these errors would be averted if medication reconciliation processes were in place.
When did the Joint Commission suspend scoring of medication reconciliation?
The Joint Commission suspended scoring of medication reconciliation during on-site accreditation surveys between 2009 and 2011. This policy change was made in recognition of the lack of proven strategies for accomplishing medication reconciliation. As of July 2011, medication reconciliation has been incorporated into National Patient Safety Goal #3, "Improving the safety of using medications." This National Patient Safety Goal requires that organizations "maintain and communicate accurate medication information" and "compare the medication information the patient brought to the hospital with the medications ordered for the patient by the hospital in order to identify and resolve discrepancies."
What is the goal of medication reconciliation?
Medication reconciliation was named as 2005 National Patient Safety Goal #8 by the Joint Commission. The Joint Commission's announcement called on organizations to "accurately and completely reconcile medications across the continuum of care." In 2006, accredited organizations were required to "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" and to 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."
Why is medication reconciliation difficult?
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 2016 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.
Can pharmacists prevent medication discrepancies?
A 2016 systematic review found evidence that pharmacist-led processes could prevent medication discrepancies and potential ADEs at hospital admission, in-hospital transitions of care (such as transfer into or out of the intensive care unit), and at hospital discharge.
Who funded the 75Q80119C00004?
This project was funded under contract number 75Q80119C00004 from the Agency for Healthcare Research and Quality ( AHRQ), U.S. Department of Health and Human Services. The authors are solely responsible for this report’s contents, findings, and conclusions, which do not necessarily represent the views of AHRQ. Readers should not interpret any statement in this report as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the authors has any affiliation or financial involvement that conflicts with the material presented in this report. View AHRQ Disclaimers
Does medication reconciliation reduce readmissions?
However, both the actual clinical effect of medication discrepancies after discharge appears to be small, and therefore, medication reconciliation alone does not reduce readmissions or other adverse events after discharge.
What are the risks of medication reconciliation?
Poor, or lack of, medication reconciliation constitutes a significant risk for medication discrepancies, errors and adverse drug reactions that can result in adverse drug events. 2 The most vulnerable patient populations are those with complex medication regimens, high-risk treatments and the elderly. Limited English proficiency and health literacy of patients and caregivers also play an important role in medication safety during transitions of care. 3 Hospital patients often have their chronic medications stopped upon admission, and they are not reordered upon discharge. During hospitalization, patients frequently receive new medications, or have medications changed because of formulary restrictions or for clinical reasons.
How to reconcile medication?
1. Set up structured communication within the organization that addresses transitions of care and medication management. Establish an organizational process and a policy around transitions of care. Include components of medication management in the process and policy.
What are the roles of pharmacists in transitions of care?
Pharmacists can play a major role on interdisciplinary teams conducting medication interventions during transitions of care. This was confirmed in one hospital-based study that also improved medication safety and had a positive impact on hospital re-presentation rates. The transitionally-focused responsibilities of the inpatient pharmacists were expanded hospitalwide, along with the role of student pharmacists and residents in obtaining medication histories, reviewing the admission medication reconciliation, and resolving discrepancies. The study estimated that for every $1 invested in pharmacist time, $12 was saved. It is noteworthy that the transition-of-care pharmacist made a total of 904 interventions (mean 2.4 per patient). 9
What is medication management?
Medication management is one of the seven foundations identified by The Joint Commission to support safe, quality transitions of care from one setting to another. 1 (See the sidebar for the seven foundations.)
What factors increase the risk of readmission?
Factors that may increase the risk of readmission include: 10. Diagnoses associated with high readmissions 10. Co-morbidities 10. The need for numerous medications 10.
How many patients have medication errors?
A study conducted by Tam et al has shown that up to 67 percent of patients have medication history errors at admission to a hospital. 4 Wong et al conducted a study that focused on the importance of understanding the frequency and type of medication discrepancy errors that happen at discharge. 5 In their retrospective study, they reported that 70.7 percent of patients had at least one actual or potential unintentional discrepancy. 5 One Canadian study found that 23 percent of patients discharged from an internal medicine service experienced an adverse event, and 72 percent of those adverse events were related to medications that could have been prevented or improved. 6
Who is excluded from the planning related to the transition process?
Patients and caregivers are sometimes excluded from the planning related to the transition process. 11
Question: Is full medication reconciliation required by PSCs to meet the Medication Education measure component?
Is medication reconciliation just a requirement for those primary stroke center (PSC)hospitals choosing Stroke as one of their ORYX Core measures or all PSCs?
Answer
All primary stroke centers are required to use the stroke measure specifications as detailed in the Specifications Manual for National Hospital Inpatient Quality Measures, Version 3.1a. This is the only one source of stroke measure specifications.
Is implementing such orders or protocols outside of the scope of practice of RN?
6. Implementing such orders or protocols is not outside of the RN scope of practice as defined by state law/regulation.
Is a protocol required for a medical record?
5. The use of a protocol is not required. However, if an organization chooses to utilize a protocol, the review and approval process must comply with the requirements found at MM.04.01.01 EP 15. The medical record must contain evidence of an order to implement the protocol, as well as the protocol itself.
Does patient preference create a therapeutic duplication?
3. The inclusion of patient preference into the medication order does not subsequently create a therapeutic duplication with other prescribed medications.
What is the challenge of medication reconciliation in an ED?
While strategies for reducing medication errors in the ED don’t stray far from how it’s performed in other areas of the hospital, one challenge unique to EDs is determining who will perform medication reconciliation. With a high number of rotating staff members typically with varying levels of medication experience, there can be tremendous uncertainty surrounding who will take care of medication reconciliation.
What happens when medication history is captured incorrectly?
When a patient's medication history is captured inaccurately during admission, the misinformation can follow a patient throughout their treatment, potentially leading to harmful medication errors and increased costs for patients and organizations.
How many people have taken at least one medication in the last 30 days?
Did you know that about half the U.S. population has taken at least one prescription medication in the last 30 days? During that same timeframe, nearly 25% of individuals have used at least three prescription medications, and more than one out of every 10 individuals has used five or more prescription medications.
Why do hospitals have 50% of medication errors?
The Institute of Medicine found that 50% of all medication errors and 20% of adverse drug events in hospitals occur due to poor communication during transitions. Here are a few reasons that medication reconciliation should receive greater attention.
What to do if you don't have a medication list?
If you don’t have the medications in-person or in a list format provided by patients, focus on improving communication. You can take steps like communicate using a patient’s preferred language, asking open-ended questions, and being on the same physical level, with both parties sitting or standing.
Why is it important to make sure such a policy and procedure are implemented on the front end?
Making sure such a policy and procedure are implemented on the front end is important to preventing errors down the road.
Should patients be blamed for medication mishaps?
While patients should not be blamed for medication mishaps, they do have the responsibility to report issues with medications that may lead to health risks and complications. Clinicians must teach patients how to recognize problems early so that they can reach out for help when needed.
