ACEP, AAEM, ENA outline their objections
In a May 30, 2006, letter under the letterheads of all three organizations, the American College of Emergency Physicians (ACEP), the American Academy of Emergency Medicine (AAEM), and the Emergency Nurses Association (ENA) voiced their objections to National Patient Safety Goal No. 8 from the Joint Commission on Accreditation of Healthcare Organizations. That goal calls for "accurate and complete" reconciliation of medications across the continuum of care. In the letter, they specifically enumerated their objections to "the compilation of a drug list for essentially each ED patient and the dissemination of that list to either the admitting physician or the primary care physician if the patient is discharged" as follows:
- EDs would be disproportionately burdened with this task because of the large number of patients seen in the ED compared to other areas of the hospital.
- For the vast majority of patients, the compilation of a comprehensive medication list will not be germane to the patient's visit in the ED.
- Most medications administered in the ED are given on a one- or two-time basis and, as such, drug interactions with prior medications are highly unlikely.
- ED medications are fundamentally not danger-prone drugs (mostly pain medications, antibiotics, and gastrointestinal medications) and those that are (thrombolytics, blood, etc.) are administered using tight protocols.
- Primary care physicians are the appropriate physicians to determine all of the drugs that their patients are taking, and they are in the best position to modify medications based on their knowledge of the patient.
In the letter, the organizations also stated their objections to standard MM 4.10, which requires pharmacist review of orders prior to administration. They conclude their letter with the following alternative recommendations:
- Medication administration in the ED not require first-dose review by a pharmacist because a licensed independent practitioner (the emergency physician who ordered the drug based on his/her assessment of the patient) is in attendance. They support that a pharmacist be readily available (by phone or otherwise) for consultation should it be sought by emergency physicians and nurses.
- Reconciliation of medication lists should be limited to patients admitted to the hospital and conducted by inpatient personnel.
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