The COVID-19 pandemic is increasing drug shortages, particularly for generic drugs, as people are stockpiling medication.
Stockpiling can make medication reconciliation more challenging for surgery centers as they work to meet related accreditation requirements.
“As part of ensuring that high-quality healthcare is provided to patients, AAAHC standards require organizations to conduct medication reconciliation,” says Hallie Brewer, CA-AM, senior vice president of learning and development for the Accreditation Association for Ambulatory Health Care (AAAHC). “Best practices in surgery include providing patients with written instructions for discontinuation and resumption of medications prior to and after a procedure, as well as explicit instructions regarding any new medications post-discharge.”
For example, many organizations do not document medication contraindication or whether patients are taking medications as prescribed, according to a 2019 AAAHC benchmarking study. (Read more here.)
This study showed only 65% of providers documented whether a patient was taking medication as prescribed. In 16% of charts, providers failed to document that a new medication was started and when. Sixteen percent of organizations did not report documenting whether there was a medication contraindication with the use of any medications listed.
The repercussions can be life-threatening when a patient does not resume a critical medication, such as an antiplatelet or anticoagulant, or when they resume the medication too early. Among the biggest problems in medication reconciliation are age, language barriers, hearing/visual/cognitive impairment, cultural issues, polypharmacy, and health literacy.
When it comes to providers and organizations, providers may not be updating medications at each encounter routinely. They may not engage in detailed discussions about medications with patients and caregivers. Further, providers may not provide enough explicit instructions regarding stopping medications before the procedure and resumption of medications after the procedure. This could include instructions on new medications to be taken after discharge.
Brewer suggests five steps as general best practices in medication reconciliation:
- Commit to medication reconciliation as part of the organization’s safety culture.
- Implement a single source document policy for tracking patients’ current and past medications.
- Verify and document medications before and after each patient exam and procedure.
- Resolve any discrepancies by communicating with the patient, provider, and pharmacy.
- Communicate with patients and ask them to verify they agree with the current medication list.
“By vigilance and fostering communication among providers themselves and with patients/caregivers, the process of medication reconciliation may result in improved coordination of care, increased patient engagement and satisfaction, and increased overall quality of care,” Brewer says.