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Reconciliation Tracking Tool
2/28/2003 7:39:08 PM
User Comments on Reconciliation Tracking Tool
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Total Posts: 1
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Re: Just about to start
6/28/2008 10:22:21 AM
Hello everyone,
I am just about to start the medication reconcialition programe at our hospital.
Would appreciate your tips or even stepwise approach in doing so.
Regards,
Nor
Clincal Pharmacist,
Selayang Hospital
Malaysia
nkasihan@gmail.com
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Mona Shah
Total Posts: 1
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Re: Reconciliation Tracking Tool
11/19/2008 11:15:37 AM
has anyone created a medication review tool to meet TJC MM 4.10 standardsin the emergency department?
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Janis Jimmie
Total Posts: 1
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Re: Just about to start
1/15/2009 5:33:05 PM
I am challenged by med reconciliation in a small ER that sees over 16000 clients in a year. If anyone has a similar dept that has created a tool that does not impose more time on an already stretched system please share
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Total Posts: 243
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Re: Just about to start
1/21/2009 10:44:49 AM
Janis,
I would be interested to know what type of process you are currently using.
The best advice we offer from IHI is KEEP IT SIMPLE. Often we find that at hospitals good intentions sometimes result in making this more complex than necessary.
In the ED, it should not be necessary to complete the entire medication reconciliation process for admitted patients. In fact, it makes sense for only a portion of it (the medication list) to occur in the ED. The reconciliation of orders cannot occur until after all orders have been entered, so unless the patient is being held in the ED for a long period, this should occur on the inpatient unit. Some hospitals learned that it should occur twice because patients in the ED are so often stressed and not accurate with remembering everything.
When a patient is not admitted, the ED physician need not re-verify all of the patient's prior medications, indeed it is generally not safe to do so since the decision for these meds and doses were made by other specialists. The ED physician should only be verifying that there is no reason to hold or change these meds based on what he or she did during the visit or because of new medications prescribed.
As for a tool, remember that there is no requirement to create or use one. Some places have developed tools that assists in the process and others have processes with no additional tools.
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Total Posts: 40
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Re: Just about to start
1/21/2009 12:41:15 PM
I agree with Fran. Keep it simple.
You may be interested in the following from Joint Commission:
[8A] What is the current expectation for medication reconciliation in the Emergency Department (ED)? Can we use different levels of medication reconciliation depending on the severity of the patient’s condition?
A consensus recommendation of the American Association of Emergency Medicine (AAEM), the American College of Emergency Physicians (ACEP), and the Emergency Nurses Association (ENA) provides for three levels of intensity of the medication reconciliation process in the ED, as follows:
a. “Screening reconciliation” for all ED patients should include routinely obtaining from each patient at each ED visit a list of the patient’s current medications (usually done by the triage nurse)
b. “Focused reconciliation,” as directed by the emergency physician, based on medical relevance, should include seeking additional information about the patient’s medications (exact drug list, dosage/route, etc.) from the patient’s pharmacy, primary care physician, family, etc.
c. “Full reconciliation,” for admitted patients should be completed by the receiving inpatient unit and pharmacist
This consensus recommendation from the AAEM, ACEP and ENA is in full compliance with NPSG requirement 8A since each level includes obtaining a list of the patient’s current medications to be used when ordering or prescribing medications in the ED. Therefore, this approach is acceptable to The Joint Commission in meeting requirement 8A. [New, 1/07]
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