Saturday, November 18, 2006

Medication Reconciliation

Anyone who believes that picking the right doctor is all there is to maximizing the odds of a good outcome needs to learn about medication reconciliation.

We all know about those little plastic boxes that hold the pills to be taken at various times throughout the week. For we seniors, it seems like being on a half dozen or more medications at any one time is now par for the course.

But when we are admitted to the hospital, we aren’t allowed to bring our medications with us (maybe somebody ought to re-evaluate that one of these days). We are given the meds ordered by the doctor, issued by the hospital pharmacy, and administered by the nurse. Then when we leave the hospital, we are given a handful of prescriptions intended to continue the course of care we were on while hospitalized.

So there are two “handoffs” there, one from ambulatory status to hospitalization and another from hospitalization back to ambulatory status (or transfer to another facility). It doesn’t take much imagination to see the opportunities for mistakes – misinformation about the drugs the patient had been on before, failure to match the discharge prescriptions with the inpatient drug regimen, misunderstandings on the part of the home going patient about whether to resume the drugs being taken prior to hospitalization, etc. etc. etc.

Medication reconciliation is the term used to describe a formal program that traces drug usage before, during, and after hospitalization to prevent drug errors occurring during those handoffs. The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has adopted medication reconciliation as one of its patient safety goals. Hospitals are struggling to comply and grousing because JCAHO gave them only a year’s notice (Modern Healthcare, November 13, 2006).

An effective program of medication reconciliation requires the design and implementation of a system applicable to clinical care. Hospitals are not very good at that. Management is expected to stay out of clinical matters and leave such things to the doctors and nurses.

Clearly, that has to change. The Modern Healthcare article quoted a Seattle hospital pharmacist as saying “It’s things we should have been doing.”

The syntax may be a little awkward, but you can’t quarrel with the thought.

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