Geriatric Reconciliation: A Case Study

Further research into my experience has revealed similar scenarios being played out across long-term care facilities nation wide (Kirsebom, Wadensten & Hedstrom, 2013). Premature discharging from hospitals has resulted in medication discrepancies, incomplete discharge orders, and inappropriate medical treatments. Recent studies show that three out four skilled nursing facility admissions experience medication discrepancies from the discharging institute (Tjia, Bonner, Briesacher, McGee, Terrill & Miller, 2009).

Goal three by the National Patient Safety Goal for 2014 is to use medicines safely. Many errors occur regularly with medications which is why communication is so important with the doctors, nurses and patients. One process that Joint Commission requires in accredited HCO’s is medication reconciliation “creating the most accurate list possible off 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 to the patients at all transition points within the hospital (Finkelman & Kenner, 2012, p. 388)”. Ensuring medication reconciliation to the patient, health providers and any new consults that are

The purpose of this paper is to bring forth awareness when it comes to patients and medication errors and further educates health care professionals on the importance of communication especially during transition of care. According to Williams and Ashrcoft (2013) “ An estimated median of 19.1 % of total opportunities for error in hospitals.” Although not all medication errors occur during transition it is the time most prevalent for these errors to occur. As per Johnson, Guirguis, and Grace (2015) “An estimated 60% of all medication errors occur during transition of care. The National Transitions of Care Coalition defines a transition of care as the movement of patients between healthcare locations, providers, or different levels of care within the same location as their conditions and care needs change, [and] frequently involves multiple persons, including the patient, the family member or other caregiver(s), nurse(s), social worker(s), case manager(s), pharmacist(s), physician(s), and other providers.”

One of the critical core components of Skilled Nursing Facility is medication administration. As cited by Tenhunen, Tanner, and Dahlen (2014), they stated that 88% of the residents living in the nursing homes are aged 65 years old and older. They discussed that every five of administered medications in nursing home has one probability of error. This means that about half of the residents have the possibility of two or more medication errors daily. This applies to the Pasadena Care Center (PCC) because its residents are mostly older adults who require medications on a daily basis. Moreover, residents are prescribed with multiple medications, which make them vulnerable to medication errors. The staff at PCC is trying their best to ensure safe medication administration, however, it still in need of a major change. The goal of the proposed change is to decrease the medication errors in this organization to ensure patient safety.

When doctors prescribe medication for their patients, a local retail pharmacy is most likely to be utilized to fill the order. However, there is a growing population of older Americans that are no longer able to live independently and must reside in nursing homes or assisted living facilities. In order for this vulnerable population to receive their medications, a different kind of pharmacy is needed, these are known as LTC, long term care pharmacies. Within these specialized pharmacies there are highly trained employees called CPhTs, certified pharmacy technicians who are overseen by state licensed

Due to the large number of consumers being prescribed multiple medications, and the complexity of managing those medications, it is of a major safety concern that systems are in place for clinicians to reconcile patients medications to resolve any discrepancies in what the patient is using, or should be using, and newly added ones.

The cost of caring for super-utilizers is high, with estimates showing that they represent only 3 to 5% of the U.S. population, but account for 30 to 50% or more of total spending (Johnson). The enormous spending is caused by high inpatient and emergency department (ED) use, a portion of which may be avoidable (Johnson). A vast majority of Medicare super-utilizers have multiple chronic conditions (MCC) and use multiple concurrent medications. Additionally, these super-utilizing patients experience frequent transitions of care and are particularly vulnerable to experiencing drug therapy problems (DTP), medication discrepancies, and medication nonadherence at each care transition. Because regular and long-term use of prescription medication is critical for the treatment of chronic conditions, medication nonadherence could be a significant barrier to achieving optimal treatment goals in this high-risk population.

Medication Reconciliation is defined by the Joint Commission as the process of checking and rechecking a patient’s current medication list to the patient’s orders. Within a MedRec program, three steps must be followed to ensure patients have the correct medications at admission and discharge: Verification, Clarification, and Reconciliation (Greenwald et al., 2010; Ruggiero et al,. 2015). MedRec should not occur once, but multiple times especially when a patient moves from department to department. The more a patient moves, the more liable they are for a medication error due to poor communication. MedRec is done for the simple reason of catching those medication errors and correcting them before they can do any harm (The Joint Commission, 2006). Medication errors effect nearly 1.5 million people who enter the hospital setting in the USA. At least every patient has one medication discrepancy between admission and discharge, which leads to rehospitalizations due to hospital-setting medication errors (Institute of Medicine as cited by Wilson et al,. 2015). With nurses at the forefront of a patient’s medication regime, pressure is put on them to provide the necessary education and safety to prevent medication related rehospitalizations. Included in the causes for medication errors is miscommunication between departments taking care of the same patient (Allison et al., 2015). Many medication errors are preventable by the implementation of electronic orders. The use of electronic

This journal talks about it takes failure to resolve medications across changes in care is an important cause of harm to patients. There is not a lot to known about medication discrepancies before patients are admitted to a skilled nursing facilities. To describe the prevalence of, type of medications involved in, and sources of medication discrepancies upon admission to the SNF setting. Cross-sectional study. Patients admitted to SNF for subacute care. Number of medication discrepancies upon admission to the SNF setting. Cross-sectional study. Patients admitted to SNF for subacute care. Number of medication discrepancies, defined as unexplained differences among documented medication regimens, including the hospital discharge summary, patient

In order to evaluate and compare medication compliance the patient’s discharge medication reconciliation were compared to patient’s medication list at time of first office visit. Of the patients in population 1 (N=82), 71 were seen back for follow up and 11 never returned. Of the 71 that returned for follow up 97.18% (N=69) were compliant with discharged core measure medications. Population 2 (N=104), 97 were seen back for follow up with 7 never returned. Of the 97 seen back for office follow up 100% (N=97) were compliant with discharged core measure medications. Statistical analysis of the two population did not find a statistically significant difference (p= 0.0991).

In the Care About Your Care video discussion one of the transitional care implementations was a nurse visit after leaving the hospital. In the article, Transitional Care Interventions Prevent Hospital Readmissions for Adults with Chronic Illnesses, the author’s identified that same intervention of a nurse visit, but stipulated that the visit should be within three days of discharge and be performed by a registered nurse or advanced-practice nurse, along with other interventions such as, “care coordination by a nurse and communication between the primary care provider and the hospital” (Verhaegh, MacNeil-Vroomen, Eslami, Geerlings, Rooij & Buurman, 2014). During the nurse visit it would be beneficial to perform a drug reconciliation to reduce

To ensure the best health care provided to older adults, nurses need to apply the nursing process to all their patients to reduce their hospitalization and help them live better lives. This also provides the health care provider all the information needed to plan their care. L. Lilley, S. Collins, and J. Snyder (2013) explain the importance of lifespan considerations with elderly patients, “More than 80% of patients taking eight or more drugs have one or more chronic illnesses. More complicated medication regimes predispose elderly patients to self-medication errors, especially those with reduced visual acuity and manual dexterity.” (p. 43) Considering our patients age of being over 65, special considerations are needed

As well as using multiple physicians, elderly clients may use more than one pharmacy. Each pharmacy attempting oversight of the client’s medication use may not be aware of all the medications prescribed.

According to the Institute for Healthcare Improvement, “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” (Institute For Healthcare Improvement, n.d). This process includes three steps: collecting the medication history, ensuring that the medications and dosages are appropriate for the patient, and documenting the changes in the orders. This occurs when the patient is admitted, transferred and discharged from the hospital (Institute for Healthcare Improvement, 2011). The purpose is to avoid any duplications, incorrect

In their 2015 paper, “Effects of Low Blood Pressure in Cognitively Impaired Elderly Patients Treated with Antihypertensive Drugs”, Mossello et al. completed a prospective cohort study of, ultimately, 172 patients in Italy, with a mean age of 79, from 2009 to 2012, with MCI or dementia, to see the effects of systolic blood pressure readings or use of antihypertensive medications could predict the progression of cognitive decline. Using the MMSE as their metric to measure cognitive decline over time, they found a statistically significant increase in the rate of cognitive decline in the group that had daytime SBP 145 mm Hg groups. Subgroup analysis also showed that effect persisted only when look at those treated with anti-hypertensives, and