Medication Reconciliation Meets Patient Safety
One didn’t have to watch this year’s presidential address to know that this motherhood-and-apple-pie line probably drew enthusiastic applause from both sides of the aisle. Who doesn’t want to reduce costs and medical errors? Who doesn’t want better information technology? Who wouldn’t ardently support a nonbinding resolution to improve the quality of health care, casting political caution to the wind?
But while we wait for the popular rhetoric to translate into reality—for the dream of technological “interoperability” to come to fruition; for computers in one system to communicate with computers in another; for medical records from the outpatient setting to be quickly transferred to the inpatient environment, and vice versa; and for health plans, health care providers, and vendors to cross their own virtual aisle and have a big group hug—many in the health care community are vigorously pursuing new error-reduction initiatives. New policies are rapidly being implemented, whether or not all of the fine details, complexities, and practicalities of the actions have been considered.
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The latest well-intentioned initiative, which just happens to be a Joint Commission National Patient Safety goal, is the Medication Reconciliation Project. Piggybacking on the quasi-spiritual Institute for Healthcare Improvement movement, the Joint Commission, in 2005, issued a new commandment that went into effect last year:
Thou shalt reconcile medications.
In case the term medication reconciliation leaves you feeling bewildered, allow me to try to reconcile you to this jargon with the following definition:
Medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten.
This makes perfect sense to me. What madman would oppose such a feel-good concept?!
Dr. Greengold is Vice President and Medical Director of Hearst Business Media in Los Angeles, California.
I see patients part-time in an urgent-care internal medicine practice setting, so I know first-hand the challenge of trying to “take care” of people whom I’ve never met before—when often no medical chart is available and frequently the best medication information patients offer me has to do with the color of the pills they pop and the certainty that the drug name begins with an “A” or a “D.” Having no knowledge of which medications a patient is taking or was prescribed can greatly hamper our ability to assess and treat, to pinpoint possible drug interactions and duplications, and to consider possible side effects.
To address this concern, and as a critical step toward making “medication reconciliation” meaningful, many groups advocate developing a simple template for the patient to fill out. In the absence of an electronic medical record (EMR), if patients would just carry around a “universal medication form”— like an insurance card or driver’s license—listing all of their drugs and doses (including over-the-counter and herbal products) and the name of each pre-scriber, as well as their history of allergies and reactions to drugs, we would be in a much better position to serve those patients. Right?