Medication Reconciliation: A Case Study

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

As a critical care nurse the concern with medication shortages really hits home. In my current practice I have been asked by our hospital pharmacy to decrease the amount of Ativan given to a patient because the supply was low and they did not have any more to restock our omnicell. I am unsure the reason behind this particular shortage, but several other drugs we currently use are in low supply, most importantly epinephrine. Epinephrine is a life-saving medication, not only for supply on our code carts for cardiac arrest, but available in injection form for people with severe allergies. The shortage affects everyone, from oncology patients to cardiac patients. Recent policy changes have been made in order to correct the major shortages to help keep these life-saving drugs on the market and available to the people that need them.

Many medication errors comes from miscommunication between the physicians, pharmacists, and the nurses. As nurses, we should eliminate these barriers of communication and always verify drug information, and also communicate among team members. The most effective way to promote communication among our colleagues at work is to use the “SBAR” method which means situation, background, assessment, and recommendations. I read a journal at American Nurses Association website about a patient who died because of poor communication among team members. A patient died after labetalol, hydrala¬zine, and extended-release nifedipine were crushed and given by NG tube. Crushing extended-release drugs allows the entire dosage to be absorption immediately. As

M e d i c a t i o n R e c o n c i l i a t i o n : A K e y I s s u e i n M e a n i n g f u l U s e

Phansalkar, S., Her, Q. L., Tucker, A. D., Filiz, E., Schnipper, J., Getty, G., & Bates, D. W. (2015). Impact of incorporating pharmacy claims data into electronic medication reconciliation. American Journal Of Health-System Pharmacy, 72(3), 212-217 6p. doi:10.2146/ajhp140082

The activity that I performed and relates to this outcome is medication reconciliation. I performed this activity in my IPPE-III class as a PS-III student. It was a mandatory activity, which I carried out in workshop in the group of 4 students. In this activity, we were given a patient case, which had list of all the medications that patient was taking and had patient’s demographic information. After reviewing patient’s given information, I had to interview a standardized patient and find out if the patient is taking all the medications as directed by prescriber or not. If patient is taking any other vitamins, herbal or OTC medications that is not on the list and also had to look out for if there is any discrepancy with the medications patient currently on for example, duplicate therapy, drug-drug interaction, incorrect frequency etc.

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

The SCHC addressed meaningful use by recording patient demographics, maintaining an active medication lists and incorporating clinical lab test results into the HER, as apart of their meaningful use objectives. For recording patient demographics, they maintained data for accurate billing and ensured that the practice workflow was adjusted to capture all of the necessary patient data. They addressed active medication lists by following the requirements for e-prescribing. Patients were able to review their active medication list during their visit. Changes to the medication list were reviewed with the nurse and adjusted within the EHR system by the doctor. They communicated information for the care coordination process by making test results efficient and safe to access. Physicians were able to make real time decisions when they receive the test results from LabCorp, Quest, and other health

First, the medical assistant should convert the doctor’s prescription into layman’s terms for Doris. Medication A is two teaspoons by mouth every four hours. Medication B is 2.5 milliliters by mouth three times daily (Fulcher, Fulcher, & Soto, 2012, p. 1b). Doris should be cautious of confusing her medication dosages as that could lead to possible overdose. If Doris is afraid of mixing her medications, the medical assistant should convert to the unit that Doris is more comfortable with. For example, if Doris prefers milliliters, she should take around 9.8 milliliters of medication A. Alternatively, medication B could be taken at .5 teaspoons (Fulcher, Fulcher, & Soto, 2012, p. 131). Patients taking multiple medications should have a medication

The PC will randomly select 25 participants, aged 65 years and older, who are patients in a primary care setting, who have at least one chronic disease, are Haitian Creole speaking only, and who take more than five medications daily. Those patients will meet monthly and will bring their pill bottles for medication review. Two Haitian Creole speaking pharmacists will be recruited to participate in the program. They will gain access to the participants' electronic health records (EHR) for the duration of the program. During each visit, the pharmacists will inquire about participants' medication use including over the counter medications, reason for taking the medications, the duration of the treatment, the use of different providers, and participant's

AHIMA recognizes that superior quality health care and clinical data are critical resources needed for effective healthcare, and works to assure that the health information used in care, research, and health management is valid, accurate, complete, trustworthy, and timely. This group is concerned about the effective management of health information from all sources and its application in all forms of healthcare and wellness preservation. Health issues, disease, and care quality also transcend across national borders. AHIMA’s professional interest is in the application of best health information management practices when and wherever they are needed. (The American Health Information Management Association, 2010).

The reporting party (RP) stated she was recently terminated due to leaving residents alone in the facility and discussing missing narcotic medications. The RP stated on at least two occasion residents' medication became missing. According to the RP a female resident (name unknown) who passed away shortly before Thanksgiving was missing her "Norco." Additional a resident named Richard was missing his evening dose of "Lorazepam." Subsequently the RP discussed the missing medications with the Nurse and Executive Director; however, the missing medications were not reported to CCL. The RP stated that the medication staff are not properly trained in assisting residents with their medications. According to the RP many prescription medications have

Surescripts collects data from the pharmacy which is available to e-prescription. This provides physicians with information on medications patients paid out of pocket by insured and uninsured patients. When physicians collect a comprehensive medication history, this can enhance physicians to use the Surescripts e-prescription feature for medication reconciliation. A comprehensive medication history may improve drugs interaction alerts which decreases the chance of medication errors and the number of duplicated

Health Information Exchange is the electronic movement of healthcare information amongst organizations according to the national standards. HIE as it is widely known, serves the purpose of providing a safe, timely, and efficient way of accessing or retrieving patient clinical data. Health Information Exchange allows for doctors, nurses, pharmacists, and other vital healthcare professionals to have appropriate access and securely share vital medical information regarding patient care. Health Information Exchange has been in efforts of developing for over 20 years in the United States. In 1990 the Community Health Management Information Systems (CHMIS) program was formed by the Hartford Foundation to foster a development of a centralized data repository in seven different geographically defined communities. Many of the communities struggled in securing a cost-effective technology with interoperable data sources and gaining political support. In the mid-1990s a similar initiative began known as the Community Health Information Networks (CHINs) with the intention of sharing data between providers in a more cost-effective manner. In 2004, the Agency for Healthcare Quality and Research Health Information Technology Portfolio was funded $166 million in grants and contracts to improve the quality and safety to support more patient-centered care. This was the beginning of the progress we have seen in HIE today. Health Information Exchange devolvement serves the purpose of improving

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