The Nurse's Role in Medication Reconciliation - BC Patient Safety ...

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The Nurse’s Role in Medication Safety precipitate one or more allergic reactions, food and drug interactions, and/or drugdrug interactions. Medication reconciliation is an extremely important process that needs to take place every time a patient is involved with any health care system. Therefore, medication reconciliation was clearly an excellent choice when, in July 2004, Our Lady of Lourdes Memorial Hospital, Inc., Binghamton, New York (Lourdes Hospital), was asked by Ascension Health Ministries to participate in one of the eight Priority For Action Teams, whose goal was to have no preventable deaths by July 1, 2008. Medication reconciliation was one way to achieve that goal. The Adverse Drug Event (ADE) Priority for Action (PFA) Team selected by Lourdes Hospital was to be mostly composed of direct patient care nurses from all departments (from inpatient to outpatient) and management from various clinical and nonclinical backgrounds, including a pharmacist, a clinical nursing director, a physician, a management engineer, and the chief nursing officer. During the initial team meetings, a crystal clear definition of medication reconciliation was agreed upon so that the medication reconciliation task could be implemented across the organization. (See the box below for the definition of medication reconciliation as well as the language for National Patient Safety Goal 8, which pertains to medication reconciliation.) Because this particular chapter pertains to the nurse’s role in medication reconciliation, it is presented in the nursing process format, wherein the nursing assess- Medication Reconciliation: The process of comparing a patient’s medication orders (those newly prescribed) with all the medications the patient takes (previously prescribed as well as self-prescribed, including over-the-counter products such as herbals and supplements). 1 National Patient Safety Goal 8 Accurately and completely reconcile medications across the continuum of care. Requirement 8A: There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization. Requirement 8B: A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner, or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility. 12
Chapter 1: The Nurse’s Role in Medication Reconciliation ment leads to the diagnosis of the problem, the planning of the goals and outcomes is followed by the implementation of the process, and subsequent evaluation and measurement dictate the success or failure of the process. Assessment Assessment of the issues involved with implementing medication reconciliation by using a pilot unit In September 2004, the organization chose the cardiac telemetry unit as a pilot unit in which to assess and introduce the idea and subsequent use of medication reconciliation. The first test of change for the new process included the following participants: • One nurse (who was a member of the ADE team) • One physician (who admitted a high number of patients to the pilot unit and would be amenable to change) • One patient (who was typical of the patient population and had an accurate list of current medications) Prior to enacting the new process on the pilot unit, medication reconciliation was designed with the nurse, physician, and patient in mind. In the beginning, the hospital system considered several factors: change theory, adult-learner theory, additional paperwork, staffing crises, and the typically hectic, busy nature of a nursing unit. The nurse on the pilot unit as well as the selected physician had to be convinced that the benefit of medication reconciliation outweighed the burden of yet another change, more paperwork, and the potential for being overwhelmed. At first, the medication reconciliation process seemed complicated. Staff members perceived the additional paperwork as tedious. The nurses were naturally resistant and reluctant to embrace another change. They needed to know that the ADE team empathized with them and the ADE team needed the support of the nurses for the process to be successful. The process was to compare the patient’s current medications with the medications that the physician ordered on admission to the hospital. That seemed simple enough; however, it was a change to the process and procedure, which created a new, time-consuming, detailed system that was absolutely necessary (and soon would be supported by policy). Fortunately, when the organization presented the process change to nurses from the perspective of patient safety, nurses recognized its importance. After the test of change on the pilot unit by the core individuals involved was successful, the idea was to spread the change. Nurses were beginning to incorporate and streamline medication reconciliation. The first test of change identified issues that the health care team had not considered, including the following: 13
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