Medication Reconciliation

Medication Reconciliation
A recent survey of 60 hospitalized patients in Colorado showed that almost all of them were unable to correctly list the medications they were prescribed. JCAHO has been trying to get all hospitals to reduce medication errors, and many of us have instituted medication reconciliation as part of our admission and discharge processes. In light of this survey, it would be useful to think further about the education our patients receive while in the hospital concerning the medications we are administering to them.

Our hospital has not made the full transfer to the automated medication dispensing system. We still use the paper MAR with labels. Having the drug dispensed in the room, from a medication cart, would seem to increase the likelihood of inpatient teaching. It would seem to encourage patient participation in awareness and knowledge about their own care. The paper system has many flaws at our current stage of transition to the automated system. We have many labels, sheets of paper, and it is visually messy and distracting. The font is small and probably not conducive to patient learning.

My vision is of a nursing case management role, similar to the congestive heart failure or cardiac rehab nurse, who meets daily with each patient to explain the medications the patient is receiving, any changes to those medications, and a plan of care discussion focused on how those medications can either be eliminated through changes in lifestyle or not eliminated based on the severity of need. A good example would be a Type II diabetic. This patient could benefit by understanding that the oral medications can be eliminated with physician collaboration if they are able to consistently change diet and exercise patterns, but that other medications are crucial to protecting their heart, lungs, and kidneys, and may need to be taken long-term.

Once patients truly understand the underlying reasons for the medications they are taking, it would become easier for them to name the drugs and remember them. The reason they don’t remember them now is because they have been given no reason to understand or care. They just “do what the doctor says” and hope for the best. This is not the perspective that fosters healthy lives. That type of fatalistic thinking is exactly the reason so many people end up in polypharmacy and the resulting adverse affects.

People need to guided toward becoming fully invested in comprehending and participating in medication reconciliation and better health overall. This only comes about through a concerted, holistic educational approach. This directly relates to Orem’s self-care deficit. It is truly impossible to achieve complete health if there is an aspect of living that the patient is incapable of doing for themselves. The only way a patient can be safe and proactive with their medications is if they understand them. Obviously, this is discussion is dependent on the patient’s cognitive abilities and resources.

Adding a role to the already overworked floor nurse seems daunting. Without the case management role, I do not believe institutions will achieve the goal of reduction in medication errors and increased medication compliance at discharge. Our rates of re-admission will continue to rise, and the cost to families and hospitals won’t improve. This role should be viewed by management as a cost-saving measure, in addition to the increase in satisfaction of the patient with their care.

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