ED Accreditation Update: Form reconciles meds, but doctor buy-in difficult
ED Accreditation Update
Form reconciles meds, but doctor buy-in difficult
To meet the National Patient Safety Goal to reconcile medications across the continuum of care, one ED is finding success with a medication reconciliation form that it developed.
The National Patient Safety Goal requires hospitals to implement a process for documenting a list of the patient’s current medications upon the patient’s admission and with the involvement of the patient. This process includes comparing medications the hospital provides to those on the list.
The ED manager at Providence Saint Joseph Medical Center in Burbank, CA, developed a form that includes sections for drug name, dose, route, frequency, reason, and last dose.
For nursing home patients who bring in a list of their medications, the staff members confirm that all areas of the form are documented on the patient’s form, then they add a note that says "see attached sheet."
The form is used in the ED and for inpatients being boarded in the ED. The ED is developing a policy to use the form for reconciling medications for those inpatients boarded in the ED, says Carol Rozner, RN, MICN, BSN, ED manager. In the comments section, nurses can write additional information such as a patient not taking his or her medications regularly. Also in that section, nurses write the medications, and physicians mark them as continue, delete, or hold. The form also is used hospitalwide for inpatients when the hospital’s computer system is down.
Story highlights form’s importance
To help obtain staff buy-in for the form, Rozner shared the story of one staff member’s mother. A physician ordered thyroid medication, but a decimal was placed incorrectly. "The form would have helped if the doctor at the time of discharge reconciled all medications and looked to see that was not a therapeutic dose," Rozner says. The mother was on the wrong dose for more than a year until she was hospitalized again, she says. The mistake was caught when the patient was readmitted, she says.
Another benefit is that physicians can ensure that there aren’t any interactions between medications, she says. In the past, they might have looked at medications in terms of safety during pregnancy, or whether they were safe for a certain age child, Rozner says. "Now we look at all medications to make sure it’s safe for them to take," including medications that are prescribed as part of the patient’s discharge.
The form has been well received by floor nurses receiving patients from the ED, she says.
Training staff to use form
Implementing the form in the ED required a one-hour training course. "We held an update class this fall, and every person, including techs in the ED, came," Rozner says.
Additionally, staff members were required to complete a 10-minute self-study module on the computer. The module includes a copy of the form and explains the sections that nurses complete. "It explains the National Patient Safety Goal and why it’s necessary," she says. "It’s not just busy work; it’s important."
Using the form took some adjustment by the staff. "It’s cumbersome for the staff," Rozner says. "We didn’t used to have to ask all those questions, but those are all elements that are required," by the National Patient Safety Goal.
Some of the physicians still are disgruntled. They have raised objections because they aren’t the patients’ primary care physicians and they don’t know what medications that physician actually ordered, Rozner says.
Very time-consuming’
While one physician describes the form as a "great idea," he says that operationally it creates tremendous problems in the ED. "It’s very time-consuming, and the ED physician doesn’t need that information on most patients," says Philip Schwarzman, MD, FACEP, medical director of the ED at Providence St. Joseph.
Previously, ED nurses would list medications without the dosages. "If the ED doctor needed more, he or she could get it," Schwarzman says. Currently, a patient may come in who is on 10 or 15 medicines, some of which are "trivial," he says.
One solution may be to narrow the focus of the form to patients who will be admitted, Schwarzman says. "Most of our patients that come in get discharged," he says. "Maybe only half get a prescription." He questions the need for such a form for patients who have not be taking medications but are given a prescription. "There is redundancy," he says.
Another potential snag with the form is that physicians have to remember to sign the form, he says. "From my experience, most of us are not signing the form," he says. "We’re too busy, and nurses aren’t reminding us."
There is a need for more physician compliance, Rozner acknowledges. The managers are performing ongoing audits to determine compliance, she says.
Source/Resource
For more information on the medication reconciliation form, contact:
- Carol Rozner, RN, MICN, BSN, ED Manager, Providence St. Joseph Medical Center, Burbank, CA. E-mail: Carol. [email protected].
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To meet the National Patient Safety Goal to reconcile medications across the continuum of care, one ED is finding success with a medication reconciliation form that it developed.Subscribe Now for Access
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