ED Accreditation Update
Medication reconciliation: Another change planned
Standard may be released in a few months
As The Grateful Dead might say if asked to describe the various iterations of the National Patient Safety Goal (NPSG) for medication reconciliation, "what a long, strange trip it's been." In the latest installation of the saga, The Joint Commission announced in the Aug. 4, 2010, issue of Joint Commission Online that it would be "presenting a revised requirement based on the field review comments" to its Standards and Survey Procedures Committee in October.
In fact, as of this writing, The Joint Commission already has submitted proposed revisions to the Joint Commission Hospital Professional and Technical Advisory Committee, chaired by James J. Augustine, MD, FACEP, director of clinical operations, Emergency Medicine Physicians, Canton, OH. "By the end of the year I believe we will have a new standard in place," Augustine predicts. However, according to The Joint Commission, it would not become effective until at least July 2011.
The Joint Commission concluded revisions were needed following the field review responses. "Many respondents noted that compliance is a challenge because it involves critical issues beyond the organization's control, particularly the reliability of patient reporting of current medications," said the Joint Commission Online report.
Maureen Carr, MBA, project director for The Joint Commission, says, "People did point out that sometimes the patient is not a good historian, so that represents a challenge. It's the issue that appeared the most often. However, our position all along is that you should make your best efforts to get an accurate list, but that we would not hold you accountable for things you do not have control over."
Carr adds that "medication reconciliation compliance would not count in terms of accreditation, but we still expect facilities to meet the requirements. People should still be doing all they can to comply."
Margaret Montgomery, RN, MSN, practice management manager with the American College of Emergency Physicians in Irving, TX, says, "What is clear is that the physician can only address the information that is available, whether it is a medication list provided by the patient or from the medical record from a previous visit. Many patients do not know the names or doses of the medication that they are taking. Patients frequently describe their pills by color or shape and have no idea of the dosage."
The lack of accurate information about the patients' medication makes the medication reconciliation process difficult at best, adds Montgomery, noting that even having an electronic medical record does not guarantee accuracy. "It is only as reliable as the information that has been entered," she says.
Diana S. Contino, RN, MBA, FAEN, senior manager of health care with Deloitte Consulting in Los Angeles, says, "Meeting medication reconciliation standards continues to challenge many organizations. Some of the main reasons include: a lack of access to accurate information the single owner of the information, the patient, is not responsible to, or may not be capable of, sharing it [the medication list] with others and the lack of standardized data formats and a 'single source of truth' for patients' medication lists."
Organizations are working to create secure ways to share information between pharmacies, health systems, and insurers, and the solutions often include health information exchanges (HIE), she says. "They have the potential of incorporating demographics, medications, and results, increasing the efficiency of accessing information, and reducing the redundancy of care," says Contino, referring to repeated tests.
Montgomery says, "I think everyone is in agreement that an accurate list is best, but obtaining one in the real world is difficult. If the standard is to make a good faith effort to obtain the information, then that is realistic."
The best goal is to come up with a standard that recognizes the unique aspects in different care environments such as the ED "and provides realistic parameters to ensure appropriate care for patients and meet the standard," she says. In addition, Montgomery notes, "while The Joint Commission will not be factoring in their survey findings on the medication reconciliation NPSG until a new goal is developed, they will be looking at how hospitals are addressing medication reconciliation."
As The Grateful Dead might say if asked to describe the various iterations of the National Patient Safety Goal (NPSG) for medication reconciliation, "what a long, strange trip it's been."You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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