- Email: [email protected]
Medication reconciliation: What every nurse needs to know
PATIENT
SAFETY
FIRST
Medication reconciliation: What every nurse needs to know
A
n important National Patient Safety Goal, as stipulated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), relates to medication reconciliation across the continuum of care. The JCAHO requirements for this National Patient Safety Goal specify that health care organizations should develop a process for comparing each patient’s current medications with those ordered for the patient while he or she is under an organization’s care. This goal is applicable to office-based surgery, ambulatory care, critical access hospitals, and hospitals.1,2 Medication reconciliation ensures that a complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner, or level of care within or outside the organization.1 For 2007, JCAHO also emphasizes the importance of providing the patient with a complete list of medications at the time of his or her discharge from a health care facility. Implementation guidelines require that the organization, in cooperation with the patient, document a complete list of the patient’s medications at the time of the patient’s admission or entry into the health care setting and that a patient’s admission medication list be compared to medications ordered for the patient during an episode of care. The purpose of this comparison is to identify any differences such as omissions, duplications, and possible interactions and to resolve any of these issues.1
© AORN, Inc, 2007
Suzanne C. Beyea, RN
MEDICATION RECONCILIATION RATIONALE The rationale for establishing medication reconciliation as a National Patient Safety Goal relates to the risks that exist at the time of hand offs across settings, services, providers, or levels of care. Maintaining an accurate medication list throughout the continuum of care is one step toward increasing the reliability of care by reducing the risks of transition-related adverse drug events. The potential for serious Maintaining an adverse events led JCAHO to release a Senaccurate tinel Event Alert in January 2006 to address this medication list significant concern.3 In this publication, JCAHO for a patient reported that 63% of 350 sentinel events related to will reduce medications were attributed to communication the risk of issues, and half of the errors would have been avoided through an effec- transition-related tive process of medicaadverse tion reconciliation.3 The Joint Commission also medication reported that both the Institute for Safe Medicaevents. tion Practices and the United States Pharmacopeia (USP) had received reports of medication reconciliation errors. The types of errors reported through USP’s MEDMARX program include improper dose or quantity, omission errors, and prescribing errors.3 Another organization concerned with medication reconciliation is the Institute for Healthcare Improvement (IHI), which has identified medication reconciliation as a key initiative of the 100,000 Lives Campaign.4 The IHI reports that poor communication is a factor in 50% of all medication errors JANUARY 2007, VOL 85, NO 1 • AORN JOURNAL • 193
Patient Safety First
JANUARY 2007, VOL 85, NO 1
and 20% of adverse drug events in hospitals.5 The IHI describes the medication reconciliation process as one that involves three steps: • verification (ie, obtaining a patient’s medication history); • clarification (ie, verifying that the medications and doses are appropriate); and • reconciliation (ie, documenting any changes in orders).6 Additional resources related to medication reconciliation are available online from IHI at http://www.ihi.org/IHI/Programs /Campaign/Campaign.htm?tabld= 2#PreventAdverseDrugEvents.
NURSES’ ROLES IN MEDICATION SAFETY Medication reconciliation requirements and initiatives at first may appear to be a burden to nurses; however, perioperative nurses can play an instrumental role in reducing a patient’s risk of adverse medication reactions. Imagine the negative outcomes that could occur if a surgeon is unaware that a patient routinely takes an anticoagulant or if a patient’s antiarrhythmic medication is not continued after surgery. Imagine caring for a patient whose regular intake of herbal medications was not revealed during the admission process and then having that patient bleed excessively during a procedure as a result of the herbal medications’ side effects. Each of these examples of potential errors or adverse events could be averted by a careful and
194 • AORN JOURNAL
effective medication reconciliation process. For these reasons, every perioperative nurse needs to understand what his or her health care organization is doing to address the JCAHO requirements. Even if a facility does not seek JCAHO accreditation, medication reconciliation should still occur.
one other individual (eg, a family member, significant other, surrogate decisionmaker) when appropriate.3 Designing an effective process by which a reliable medication list is documented and then accessed by caregivers will help ensure each patient’s safety. Obtaining accurate and complete information, however, may present some challenges for clinicians.
As part of a medication reconciliation team, perioperative nurses can play an instrumental role in reducing a patient’s risk of adverse medication reactions.
IMPLEMENTATION STRATEGIES
The fast-paced nature of most perioperative settings makes it crucial for perioperative nurses to actively participate in multidisciplinary teams that address medication reconciliation. The nuances of the preadmission process and multiple hand offs of patients make it imperative that health care facilities develop systems that address the needs of patients and involve at least
One strategy to assist in the medication reconciliation process may be to ask the patient to bring a medication list each time he or she has an encounter with the health care system. If a patient uses several different pharmacies, no one pharmacist or physician is likely to have a complete list of the patient’s medications. Patients also may use vitamins and various overthe-counter medications including sleep aides, herbal medications, pain relievers, and cold remedies. It also is essential to ask patients if they abuse medications or alcohol, as this is important information to include in any patient’s health history. The Joint Commission recommends that a patient’s medication list consistently be placed in a highly visible area on his or her chart, and that the medication list include the dose and schedule as well as immunizations and allergies or adverse drug events.3 Clearly specifying which members of the health care team are responsible is a criti-
Patient Safety First
JANUARY 2007, VOL 85, NO 1
cal step in implementing a successful medication reconciliation process. This is of even greater importance in the perioperative setting because of the increased number of patient hand offs between members of the health care team. Perioperative nurses must learn where a patient’s medication list is posted and always refer to it. This is an essential part of the process to ensure the safety of each patient. Actively contributing to successful implementation of the medication reconciliation process is an equally crucial step. Nurses should share information about this important initiative with their patients and explain the benefits of the patient providing a complete and accurate medication history.
THE IMPORTANCE OF MEDICATION RECONCILIATION Adverse drug events occur each day and in alarming numbers.7 Medication reconciliation provides one strategy that may help decrease the nature and type of errors that occur when patients come in
contact with the health care system. Perioperative nurses must be made aware of this initiative and participate in medication reconciliation according to their organization’s policies and procedures. Together with other members of the perioperative health care team, nurses can contribute to ensuring medication safety for their patients. ❖ SUZANNE C. BEYEA RN, PHD, FAAN DIRECTOR OF NURSING RESEARCH DARTMOUTH-HITCHCOCK MEDICAL CENTER LEBANON, NH Editor’s note: MEDMARX is a registered trademark of The United States Pharmacopeia, Rockville, Md.
REFERENCES 1. Joint Commission on Accreditation of Healthcare Organizations. 2007 ambulatory care/ office-based surgery National Patient Safety Goals. Available at: http://www.jointcommis sion.org/patientSafety/Nation alPatientSafetyGoals/07_amb _obs_npsgs.htm. Accessed October 30, 2006. 2. Joint Commission on Accreditation of Healthcare Organizations. 2007 hospital/critical access hospital National Patient Safety Goals.
Available at: http://www.joint commission.org/patientSafety/ NationalPatientSafetyGoals/07 _hap_cah_npsgs.htm. Accessed October 30, 2006. 3. Joint Commission on Accreditation of Healthcare Organizations. Using medication reconciliation to prevent errors. Sentinel Event Alert. January 25, 2006;35. Also available at: http://www.jointcommission .org/SentinelEvents/Sentinel EventAlert/sea_35.htm. Accessed October 30, 2006. 4. Institute for Healthcare Improvement. 100k lives campaign: prevent adverse drug events. Available at: http://www.ihi.org /IHI/Programs/Campaign /Campaign.htm?tabld=2#Pre ventAdverseDrugEvents. Accessed October 30, 2006. 5. Institute for Healthcare Improvement. Medication reconciliation review. Available at http:// www.ihi.org/IHI/topics/Patient Safety/MedicationSystems/Tools /Medication+Reconciliation+ Review.htm. Accessed October 30, 2006. 6. Institute for Healthcare Improvement. Medication reconciliation: the process. Available at: http://www.ihi.org/NR/rdon lyres/35215AA9-6572-40C1-9333 -80F895A5A8D2/0/FAQforrecon cilingmedicationsv05.doc. Accessed October 30, 2006. 7. Institute of Medicine. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building A Safer Health System. Washington, DC: National Academy Press; 2000.
Foundation Offers Ways to Support Perioperative Nursing
B
y supporting the AORN Foundation, you also support the advancement of perioperative nursing. There are many ways to extend your personal legacy to the AORN Foundation, including • naming the AORN Foundation in your last will and testament; • allocating gift annuities; • committing charitable remainder/annuity trusts; or • naming the AORN Foundation as a beneficiary
196 • AORN JOURNAL
in a life insurance policy. You can double or triple your donation to the Foundation if your employer matches your donation. To find out if your employer will match your gift to the AORN Foundation, please check with your human resources department. For more information on Foundation activities, call Nancy Harbin in the AORN Foundation office at (800) 755-2676 x 366, or visit http://www.aorn.org/foundation.
SAFETY
FIRST
Medication reconciliation: What every nurse needs to know
A
n important National Patient Safety Goal, as stipulated by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), relates to medication reconciliation across the continuum of care. The JCAHO requirements for this National Patient Safety Goal specify that health care organizations should develop a process for comparing each patient’s current medications with those ordered for the patient while he or she is under an organization’s care. This goal is applicable to office-based surgery, ambulatory care, critical access hospitals, and hospitals.1,2 Medication reconciliation ensures that a complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner, or level of care within or outside the organization.1 For 2007, JCAHO also emphasizes the importance of providing the patient with a complete list of medications at the time of his or her discharge from a health care facility. Implementation guidelines require that the organization, in cooperation with the patient, document a complete list of the patient’s medications at the time of the patient’s admission or entry into the health care setting and that a patient’s admission medication list be compared to medications ordered for the patient during an episode of care. The purpose of this comparison is to identify any differences such as omissions, duplications, and possible interactions and to resolve any of these issues.1
© AORN, Inc, 2007
Suzanne C. Beyea, RN
MEDICATION RECONCILIATION RATIONALE The rationale for establishing medication reconciliation as a National Patient Safety Goal relates to the risks that exist at the time of hand offs across settings, services, providers, or levels of care. Maintaining an accurate medication list throughout the continuum of care is one step toward increasing the reliability of care by reducing the risks of transition-related adverse drug events. The potential for serious Maintaining an adverse events led JCAHO to release a Senaccurate tinel Event Alert in January 2006 to address this medication list significant concern.3 In this publication, JCAHO for a patient reported that 63% of 350 sentinel events related to will reduce medications were attributed to communication the risk of issues, and half of the errors would have been avoided through an effec- transition-related tive process of medicaadverse tion reconciliation.3 The Joint Commission also medication reported that both the Institute for Safe Medicaevents. tion Practices and the United States Pharmacopeia (USP) had received reports of medication reconciliation errors. The types of errors reported through USP’s MEDMARX program include improper dose or quantity, omission errors, and prescribing errors.3 Another organization concerned with medication reconciliation is the Institute for Healthcare Improvement (IHI), which has identified medication reconciliation as a key initiative of the 100,000 Lives Campaign.4 The IHI reports that poor communication is a factor in 50% of all medication errors JANUARY 2007, VOL 85, NO 1 • AORN JOURNAL • 193
Patient Safety First
JANUARY 2007, VOL 85, NO 1
and 20% of adverse drug events in hospitals.5 The IHI describes the medication reconciliation process as one that involves three steps: • verification (ie, obtaining a patient’s medication history); • clarification (ie, verifying that the medications and doses are appropriate); and • reconciliation (ie, documenting any changes in orders).6 Additional resources related to medication reconciliation are available online from IHI at http://www.ihi.org/IHI/Programs /Campaign/Campaign.htm?tabld= 2#PreventAdverseDrugEvents.
NURSES’ ROLES IN MEDICATION SAFETY Medication reconciliation requirements and initiatives at first may appear to be a burden to nurses; however, perioperative nurses can play an instrumental role in reducing a patient’s risk of adverse medication reactions. Imagine the negative outcomes that could occur if a surgeon is unaware that a patient routinely takes an anticoagulant or if a patient’s antiarrhythmic medication is not continued after surgery. Imagine caring for a patient whose regular intake of herbal medications was not revealed during the admission process and then having that patient bleed excessively during a procedure as a result of the herbal medications’ side effects. Each of these examples of potential errors or adverse events could be averted by a careful and
194 • AORN JOURNAL
effective medication reconciliation process. For these reasons, every perioperative nurse needs to understand what his or her health care organization is doing to address the JCAHO requirements. Even if a facility does not seek JCAHO accreditation, medication reconciliation should still occur.
one other individual (eg, a family member, significant other, surrogate decisionmaker) when appropriate.3 Designing an effective process by which a reliable medication list is documented and then accessed by caregivers will help ensure each patient’s safety. Obtaining accurate and complete information, however, may present some challenges for clinicians.
As part of a medication reconciliation team, perioperative nurses can play an instrumental role in reducing a patient’s risk of adverse medication reactions.
IMPLEMENTATION STRATEGIES
The fast-paced nature of most perioperative settings makes it crucial for perioperative nurses to actively participate in multidisciplinary teams that address medication reconciliation. The nuances of the preadmission process and multiple hand offs of patients make it imperative that health care facilities develop systems that address the needs of patients and involve at least
One strategy to assist in the medication reconciliation process may be to ask the patient to bring a medication list each time he or she has an encounter with the health care system. If a patient uses several different pharmacies, no one pharmacist or physician is likely to have a complete list of the patient’s medications. Patients also may use vitamins and various overthe-counter medications including sleep aides, herbal medications, pain relievers, and cold remedies. It also is essential to ask patients if they abuse medications or alcohol, as this is important information to include in any patient’s health history. The Joint Commission recommends that a patient’s medication list consistently be placed in a highly visible area on his or her chart, and that the medication list include the dose and schedule as well as immunizations and allergies or adverse drug events.3 Clearly specifying which members of the health care team are responsible is a criti-
Patient Safety First
JANUARY 2007, VOL 85, NO 1
cal step in implementing a successful medication reconciliation process. This is of even greater importance in the perioperative setting because of the increased number of patient hand offs between members of the health care team. Perioperative nurses must learn where a patient’s medication list is posted and always refer to it. This is an essential part of the process to ensure the safety of each patient. Actively contributing to successful implementation of the medication reconciliation process is an equally crucial step. Nurses should share information about this important initiative with their patients and explain the benefits of the patient providing a complete and accurate medication history.
THE IMPORTANCE OF MEDICATION RECONCILIATION Adverse drug events occur each day and in alarming numbers.7 Medication reconciliation provides one strategy that may help decrease the nature and type of errors that occur when patients come in
contact with the health care system. Perioperative nurses must be made aware of this initiative and participate in medication reconciliation according to their organization’s policies and procedures. Together with other members of the perioperative health care team, nurses can contribute to ensuring medication safety for their patients. ❖ SUZANNE C. BEYEA RN, PHD, FAAN DIRECTOR OF NURSING RESEARCH DARTMOUTH-HITCHCOCK MEDICAL CENTER LEBANON, NH Editor’s note: MEDMARX is a registered trademark of The United States Pharmacopeia, Rockville, Md.
REFERENCES 1. Joint Commission on Accreditation of Healthcare Organizations. 2007 ambulatory care/ office-based surgery National Patient Safety Goals. Available at: http://www.jointcommis sion.org/patientSafety/Nation alPatientSafetyGoals/07_amb _obs_npsgs.htm. Accessed October 30, 2006. 2. Joint Commission on Accreditation of Healthcare Organizations. 2007 hospital/critical access hospital National Patient Safety Goals.
Available at: http://www.joint commission.org/patientSafety/ NationalPatientSafetyGoals/07 _hap_cah_npsgs.htm. Accessed October 30, 2006. 3. Joint Commission on Accreditation of Healthcare Organizations. Using medication reconciliation to prevent errors. Sentinel Event Alert. January 25, 2006;35. Also available at: http://www.jointcommission .org/SentinelEvents/Sentinel EventAlert/sea_35.htm. Accessed October 30, 2006. 4. Institute for Healthcare Improvement. 100k lives campaign: prevent adverse drug events. Available at: http://www.ihi.org /IHI/Programs/Campaign /Campaign.htm?tabld=2#Pre ventAdverseDrugEvents. Accessed October 30, 2006. 5. Institute for Healthcare Improvement. Medication reconciliation review. Available at http:// www.ihi.org/IHI/topics/Patient Safety/MedicationSystems/Tools /Medication+Reconciliation+ Review.htm. Accessed October 30, 2006. 6. Institute for Healthcare Improvement. Medication reconciliation: the process. Available at: http://www.ihi.org/NR/rdon lyres/35215AA9-6572-40C1-9333 -80F895A5A8D2/0/FAQforrecon cilingmedicationsv05.doc. Accessed October 30, 2006. 7. Institute of Medicine. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building A Safer Health System. Washington, DC: National Academy Press; 2000.
Foundation Offers Ways to Support Perioperative Nursing
B
y supporting the AORN Foundation, you also support the advancement of perioperative nursing. There are many ways to extend your personal legacy to the AORN Foundation, including • naming the AORN Foundation in your last will and testament; • allocating gift annuities; • committing charitable remainder/annuity trusts; or • naming the AORN Foundation as a beneficiary
196 • AORN JOURNAL
in a life insurance policy. You can double or triple your donation to the Foundation if your employer matches your donation. To find out if your employer will match your gift to the AORN Foundation, please check with your human resources department. For more information on Foundation activities, call Nancy Harbin in the AORN Foundation office at (800) 755-2676 x 366, or visit http://www.aorn.org/foundation.