ED makes big changes to med reconciliation process

At Beth Israel Deaconess Medical Center in Boston, ED nurses "made some huge changes" to their medication reconciliation process, reports Shelley Calder, RN, CEN, MSN, clinical nurse specialist for the ED.

"Before, we really were not successful with this. We were in the 50th percentile at the time, and we are 98% complaint now," she says.

The ED's former process was done on paper, but an electronic form is now used, which ED nurses complete for each patient.

"It pulls information from the patient's previous visits, so the nurse doesn't have to recreate the list every time," says Calder.

Nurses can pull up the patient's medication list, but they still go through the list with the patient to check it for accuracy. "If it's a new patient, we have to gather the entire list. But the system has a library of medications. If you type in first few letters of the drug's name, it will pop up and give the doses," she explains.

The ED physician also reviews the list with the patient, and there is an electronic page for them to enter "continue," "stop," or "add" for each medication.

"Previously, ED nurses were doing everything," says Calder. "They were collecting the list, and then based on the physician's discharge instructions, they were writing on our paper record 'continue,' 'change,' or 'stop.' They were also responsible for adding any new medications to the list and giving that to the patient."

Now, the ED nurse collects the list at triage, and the ED physician takes over from there. Later, the nurse prints the medication reconciliation sheet with the patient's discharge instructions. "This [electronic system] has made us compliant with 'do not use' abbreviations as well," she reports.


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