Adopt a team approach for med reconciliation

What should ED managers be doing while they wait for The Joint Commission to publish a new standard for medication reconciliation? Take a team approach, recommends Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles.

"This includes encouraging/educating patients to maintain medication lists either electronically or on paper," Contino says. "The ED is responsible for collecting the initial information and for making the best effort to accurately list medications so the discharging physician can note the continuation or discontinuation of the medications."

As for the other team members, the pharmacists often assist in reviewing and noting other options for medications or doses, she says. Some EDs have pharmacists on staff to assist with the reconciliation process, and others incorporate PharmD students. Inpatient staff and the discharging physicians assist in ensuring the patient leaves with instructions for the appropriate medications. The primary care physician works with the specialist to ensure that all the patients' medications are optimal.

"Since this is a process that crosses many domains, it requires a collaborative approach closely linked with the overall care coordination strategy, which for many organizations includes new programs like medical home," Contino says.

James J. Augustine, chairman of the Joint Commission Hospital Professional and Technical Advisory Committee, says, "In the meantime, ED leaders should be use their existing medication reconciliation process, and particularly for patients for whom we have a good list of existing medicines, we should use our best clinical methods to ensure we're giving medications that don't have potential reactions with existing medications."