Med-Rec 101

And so the process begins. Step one in medication reconciliation is to obtain the patients medication history. No small struggle indeed. Obtaining the history and reconciling meds upon discharge tend to be the two largest hurdles in the process. Trying to get an accurate medication history is part art and part science with a whole lot of resources tied to it. Over the past few years, there's been significant emphasis put on educating patients to either create and maintain a list of their medications and keep it with them at all times or the ever present "bring in your bottles" theory. These efforts certainly have merit and will continue but the number of patients that are "prepared" when they show up in your emergency department is inconsistent at best. Some key variations I've observed in how hospitals obtain the history.

Who

• Nurses perform the assessment 94% of the time
• Pharmacist perform the assessment 3% of the time
• Pharmacy technicians perform the assessment 2% of the time
• Physicians perform the assessment 1% of the time

How

• Hard copy document - 71%
• Hard copy document that also serves as an initial order - 24%
• Data entered electronically into clinical information system - 5%

more to come.....

Medication Reconciliation: It's a paper process, it's an electronic process, it's the physicians responsibility, it's the nurses responsibility, it's the patients responsiblity...... yes, it is in fact all of these things. The one constant i've observed in over 100 hospitals is that there is no constant. The core prinicipals still apply

• Obtain an accurate medication history
• Communicate with the next care giver
• Reconcile at each transition point
• Discharge the patient with the correct regimen

and the core issues still abound

• What is the best way to obtain a complete history
• What is the best process for communicating to the next care giver
• Who is performing the reconciliation
• Do we have enough resources to comply
• Am I making the most informed decisions

So far, i've been privy to many processes and many success stories. I've also seen an enormous amount of frustration. For the most part, there has been a shift in focus from "having" to do medication reconciliation because Joint Commission requires it to "Wanting" to do medication reconcilation because it really makes a difference in patient safety.

more to come......