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Strategies to comply with med rec requirements

After reading this article, you will be able to

1. list the steps in the med rec process

2. describe the elements of a medication summary list

3. recall additional tips for complying with med rec

4. list examples of medications

Medication reconciliation is one of the JCAHO's top-cited National Patient Safety Goals (NPSG) so far this year.

According to data from surveys taken January 1-May 31, the JCAHO reports that 20.1% of hospitals were noncompliant with NPSG #8a (list) and 17% of hospitals were noncompliant with NPSG #8b (reconcile).

Only two other NPSG requirements fared worse: #2b (prohibited abbreviations), with 36.3%, and #2c (timeliness of critical test results reporting), with 22.4%.

A third NPSG requirement, #1b (time out before surgery), fared similarly to medication reconciliation with 19.3% of hospitals noncompliant.

NPSG #8a requires a process for comparing a patient's current medications with those ordered during his or her stay in your facility.

"If you're prescribing medications, shouldn't you know what [the patient is] already on?" asked Rick Croteau, MD, the JCAHO's executive director of patient safety during a Hospital Executive Briefings session this fall. "That's all this requirement says."

But NPSG #8b "will take some time" for organizations to get down pat, Croteau conceded.

Still, both medication reconciliation goals are challenging for many facilities.

"A lot of hospitals are still figuring out the nuts and the bolts of the process," concurred Glenn Krasker, MHSA, president of Critical Management Solutions, a consulting firm in Wilmington, DE, and a former director of the JCAHO's hospital accreditation program. Krasker spoke during an HCPro audioconference about the 2007 NPSGs on September 22

"A lot of places I'm working with got cited on it," he said. "Med rec is at the top of the surveyors' list of things to check, it seems."

Hospitals are still having trouble designing a process, Krasker said-figuring out where to collect the initial data, deciding who will collect the data, what to record them on, and how they're going to hand them off to the next provider and keep the information accurate.

"I've seen places that have nothing in place," Krasker said. "Others are up and running."

Krasker suggested not recreating the wheel. "Learn from others, a lot are doing it well," he said. "Even the Joint Commission points to the Massachusetts Coalition [for the Prevention of Medical Errors] as an example of best practice."

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