Provide an accurate list for the next level of care

Some hospitals are overly complicating the process

The last important piece of the medication reconciliation process is for hospitals to provide a list of the patient’s current (continuing) medications for his or her next level of care.

This area is addressed in Part B of the 2005’s National Patient Safety Goal (NPSG) 8 of the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL. This part says, "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."

This is a list of the discharge prescriptions, says Sonja A. Nisson, PharmD, a Joint Commission surveyor and regional manager of pharmacy and diabetes at Asante Health System in Medford, OR. She spoke at the American Society of Health-System Pharmacists Midyear Clinical Meeting, held last December in Las Vegas.

Some hospitals have been overly complicating the process, she says. The discharge list does not need to include:

  • A complete medication history of the hospital stay.
  • What the patient received on the last day of hospitalization.
  • The reconciled list obtained at admission.

At the time of discharge, send the list of medications that the patient is supposed to take after discharge, Nisson suggests. "They may not all be active new prescriptions that the doctor hands out at discharge because the patient may have a supply of some of them. But it should be what medications they are supposed to take, either at discharge from the hospital to home, discharge from the hospital to a skilled nursing facility, and so forth."

Before you give the discharge list, it should be reconciled with the original list obtained on admission, and the medication list from the last day of hospitalization. "If you don’t know the reason why [medications] are not the same, you want to get that reconciled and include that in the discharges," Nisson says.

Part B should be done:

  • at discharge;
  • at transfer to a different service, level of care;
  • at transfer to a different physician.
  • For settings of care in which medications might be prescribed or administered or in which a patient’s medications might affect the results of the testing or treatment.

Hospitals have wondered if this means that they have to reconcile the medications on every patient who enters the emergency department (ED). "If patients come into the ED and nothing you are doing in the ED is going to have anything to do with changing the medications they are on, then it wouldn’t be clinically necessary to do a whole reconciliation step," Nisson says.

However, if medications would change for ED patients as a result of their hospital visit — even if they are not admitted, reconciliation would be appropriate. "It’s not black and white," she says. "It is a clinical judgment."