• E-mail
• Print
• RSS

Is medication reconciliation required between the nursing floor and surgery?

Accreditation Connection, March 3, 2006

Clearly goal 8b requires medication reconciliation for patients going from the nursing floor to surgery. Just for reference, here is the text of the pertinent paragraph in the goal:

"Implementation Expectations for Requirement 8b state:  At a minimum, reconciliation must occur any time the organization requires that orders be rewritten and any time the patient changes service, setting, provider or level of care and new medication orders are written."

Addressing medication reconciliation between surgeon and primary care or attending physician is one of the more difficult aspects of this goal to address, but addressing it is important because connecting the dots, carrying the ball, or bridging the crack during this critical juncture in the patient's course of treatment is the right thing to do for the sake of the patient. 

The failure mode is when the two physicians involved in the transaction assume too much of or from the other, or take an attitude of "dealing with these meds is outside my realm and therefore is not my job." Addressing the issue requires a paradigm shift toward mutual accountability for care of the patient about to undergo surgery.

For the inpatient, a complete list of medications should have already been reconciled and placed in the medical record. The surgeon should commit to reviewing this list along with the indications, and further commit to phoning the primary care or attending physician to reconcile any questions - particularly with respect to how any of these medications would interfere with or impact the surgeon's planned use of medication during and after surgery.  This interaction should be seamless and involve the patient if necessary. 

Other staff, including the nurses caring for the patient before, during and after surgery, anesthesia personnel, and pharmacists, all play a fail-safe/backup role to ensure mistakes or oversights do not reach the patient.

John R. Rosing, MHA, FACHE

Practice Director of Accreditation and Regulatory Compliance Services

The Greeley Company

A Division of HCPro, Inc.   

• E-mail to a Colleague
• Print
• RSS
• Archive