Safety

Get patients involved in medication reconciliation for goal compliance

Ambulatory Safety Monitor, September 8, 2005

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The JCAHO's National Patient Safety Goal Eight requires organizations to accurately and completely reconcile medications across the continuum of care. Ambulatory surgery centers (ASC) face unique challenges with this goal because their elective patients may not have a long history with the organization and thus no ongoing list of medications they take.

To make sure your facility complies with the medication reconciliation goal, Eric Alper, MD, hospitalist and physician patient safety officer at UMass Memorial Health Care in Worcester, MA, recommends a proactive approach.

Give your patients homework

During the preoperative phone interview, ask your patients to assemble their medication lists and bring them on procedure day. "Make patients responsible for providing their lists," Alper says. "If you ask them to do it at home, they can sit down with all their bottles and write down accurate information."

To ensure that patients give you all the information you need, including medication name and dosage, create a reconciliation form and send it to them before their appointment. This will guarantee you have the information you need; it will also allow you to avoid additional transcribing of information, which can lead to errors in translation. Make the forms easily accessible for your patients. Consider the following ways to send them information:

  • Instruct them how to print the form from your corporate Web site
  • Mail a letter regarding the procedure and include the medication reconciliation form
  • E-mail the form to patients

    Practice consistency

    Regardless of how your facility chooses to reconcile its patients' medications, make sure you are consistent. For example, use the same forms and put the information in the same place in all patient charts. This helps providers work from the same sheet, reduce duplication, and lessen confusion during handoffs, Alper says.

    Although successful organizations stress consistency in their services, that doesn't mean their practices shouldn't evolve and improve over time. Alper's facility updates its medication reconciliation forms regularly, and staff at the center continue to find ways to modify it.

    Some useful categories to include on a medication reconciliation form are the following:

  • Height, weight, and allergies
  • Current home medications, over-the-counter drugs, herbals, including dose, route, and frequency
  • Time of last dose
  • New medication orders on admission

    Involve the right people

    Educate your staff about the importance of medication reconciliation, not only to JCAHO compliance, but to patient safety. Include the following providers in your medication reconciliation program:

  • Nurse: The nurse who completes the initial admission history and assessment should complete the medication form that the patients bring in.
  • Pharmacist: Once you obtain a list, fax a copy to the patients' pharmacy for their files.
  • Physician: Also include physicians in the medication reconciliation. Leave space on the sheet for them to use it like an order form to continue, discontinue, or change medications.



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