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Comply: NPSG revised on med reconciliation
An elder woman brought by ambulance from an extended care facility was awake and oriented, but didn't know her medications or even the facility's name and phone number, recalls Donna Sparks, MSN, RN, CEN, director of emergency services at Baptist Hospital Miami (FL).
An ED nurse "relentlessly pursued the list of meds," says Sparks. "The transfer papers had an address only, so the nurse did a Google search." The nurse found a listing of several phone numbers before losing Internet access temporarily.
The ED nurse then enlisted the help of a social worker, who provided a list of phone numbers of extended care facilities, says Sparks. "By cross-referencing the phone numbers, the nurse was finally able to identify the extended care facility," says Sparks. "She spoke to the manager, who then gave the medications over the phone."
The Joint Commission's revised National Patient Safety Goal (NPSG) on reconciling medication information will become effective July 1, 2011. Ken Powers, a spokesperson for The Joint Commission, says that EP 2 might affect the ED because it allows organizations to identify the types of information to collect in settings where patients are not intended to be kept for 24 hours. This EP is similar in intent to NPSG.08.04.01 in the existing NPSG, notes Powers. "The NPSG was streamlined to focus on important risk points in medication reconciliation, most of which were also in the existing goal," he says.
Some prescriptive requirements were eliminated, such as those related to transfers within the organization, the need to send information to the next provider of care, and some documentation requirements, says Powers, "EP 5 is new, which addresses the need to inform the patient about keeping medication information updated," he says. (See resource box, below on how to view the revised NPSG.)
Here are some strategies to improve medication reconciliation:
Have a designated nurse record medications.
Patients often are unaware of the medications or dosages they are taking, says Patricia Bernier, RN, assistant nurse manager of the ED at University of Connecticut Health Center in Farmington. "They'll say, 'the little blue pill,' which could be just about anything," she says.
ED nurses can call the pharmacy during day shifts, but this is not possible on off-shifts unless it's a 24-hour pharmacy, notes Bernier. The ED now has a designated admission nurse from 3 p.m. to 11 p.m. who documents medications in the computerized physician order entry (CPOE) system and calls local pharmacies and family members, "which is very time-consuming," says Bernier.
Give patients medication cards.
Casie McMaster, RN, an ED nurse at St. Anthony's Hospital in St. Louis, MO, says, "We are continually educating our patients to bring in a list of current medications when they come into the ED. We have a good percentage of patients that do this now, or they will actually bring in the bottles."
Make numerous calls if necessary.
McMaster says that on a daily basis, she sees ED nurses calling doctor's offices, pharmacies, family members, and even neighbors with access to a patient's home, to get the most accurate information. "Medication errors can be deadly," she says. "Walking that extra mile is the least we can do." (See story, below, on comparing previous and current medications.)
For more information on medication reconciliation in the ED, contact:
Compare current meds with previous list
A 25-year-old woman's complaints of pain on inspiration and cough initially caused Casie McMaster, RN, an ED nurse at St. Anthony's Hospital in St. Louis, MO, to suspect pneumonia. She told McMaster that she was a smoker but took no medications.
McMaster pulled up her electronic medical record (EMR) from the previous year, which listed birth control pills.
"When asked if she continues this medication, she said 'Yes, but I didn't consider that a medicine.' I now had a better picture as to what could be going on. This could be a PE [pulmonary embolism.]"
CT results confirmed McMaster's suspicion. "A simple chest X-ray would not have confirmed a PE, but the information from the previous visit led us to think outside of the normal assumptions," she says.
Because ED nurses now enter patient medications into the EMR, they are "instantly able to compare what the patient was on in the past, to what they are on now," says McMaster. "This is fantastic, because it reduces medication errors."