Medication Reconciliation: Preventing Errors
Barsteiner (2014) defines Medication reconciliation as the procedure of comparing a patient’s prescription orders to all of the medications that the patient has been taking. The resolution is done to do away with medication mistakes such as omissions, duplications, dosing problems, or drug interactions. It must be carried out at every alteration of medical care in which new prescriptions are ordered or when current orders are rewritten. Changes in care include alterations in setting, service, nurse or doctor, as well as level of care when the patient moves to the next health facility.
Medicating patients is a daily practice of any physician or doctor’s practice life. However, there are some points in time when these professionals face the challenges brought upon their patient by administering non compatible medications. The problem do occur due to incorrect procedures during medical reconciliation, which is refer to the procedures that take place when a patient is changing the type of diagnosis he or she has been using. The effect come as a result of having used many types of prescription that the doctor did not take into account before switching to a new type of medicine..
Medical reconciliation is relevant in the patient care because it enables doctors to reduce harm to patients by providing the right medication after analyzing the patient’s medical history. By being able to understand the past medical history of a patient, the doctor, physician or nurse will be able to help eliminate many medical problems that patients face because of incorrect medical reconciliation practices. The doctors will also adopt a practice of not diagnosing patient until they are fully aware of their medical history. This paper is an in depth analysis of medical reconciliation and how it affect patients’ life. This knowledge also helps doctors in achieving national patient safety goals, eradicating negative clinical indicators and help in solving unit based problems.
Population, Patient, and Problem
The number of people getting sick because of medication mishaps is increasing around the world due to medical malpractices. Research shows that in every hospital one out of three patients suffer complications that relate to medical issues. These medical problems come as a result of medication mismatch. This population is expected to increase if proper medical reconciliation procedures are not put in place. Many people in the affected population have stated that they faced various medical harms because their doctors were not careful to study their past medical histories. This issue led to them to develop different medical complications. The patients have expressed their concerns of the number of people falling more sick or developing complications upon admission, transfer or after being discharged.
Further analysis has proved that a recent pilot study led by Etchells at Sunnybrook focused on medication discrepancies at the time of hospital admission, particularly in the differences between medication orders at the time of admission versus orders made after first obtaining a patient’s thorough medication history. It was evident from this study that indeed many medical discrepancies occur when patients change medical settings. It was also clear that of the 30 percent that had the potential of causing harm to patient, 5 percent were of lethal nature.
The patients who experience these medical errors during transition normally fail to have their medical history in place. Similarly, it takes the care giver to put a patient’s medical history in place (Jcaho 2006). It is important for care givers to know that drug histories are often incomplete if they do not state the strengths, dose and drug forms missing. This history is also not complete if there is no mention of non-prescribed medicines, such as over-the-counter or complementary medicines that are often left out of the investigation. Other investigations have indicated that between 10 to 67% of medication pasts contain at least one error.
Medical reconciliation is an issue that directly affects the patient’s life and well being, it is therefore important for care givers to strictly scrutinize the patients past medical records (Jcaho 2006). In the event that these records are not available, the nurses, doctors and patients should work together with the patients to help understand the type of medication the patient was taking. Caregivers can unravel this information by asking questions such as allergy to certain medications, previous diagnosis that the patients was having, any history of self medication and so on. If the patient is not able to answer questions like the name of the medicine, then the doctors can find out if the patients have some medication to be finished and continue from that point (Australian Prescriber, 2014).
Goals and objectives of the quality improvement projects
The main goals of the quality improvement in medical reconciliation is to ensure that nurses reduce if not eliminate harm caused to patients by medical reconciliation, to improve medical practices in nursing and the objectives of the quality improvement plan is to come up with appropriate procedures that nurses can use to help them realize all necessary medical reconciliation procedures (Australian Prescriber, 2014). After given period of time, the team of nurses will come up with data that shows the improvement of the process in their area of work. They should be able to evidently prove that significant reductions has taken place in the nursing environment with regard to the achievement of the reduction levels of patients who fall sick or get harmed after undergoing a change in diagnosis.
Another objective of this project is to equip physicians, nurses and other caregivers with adequate knowledge on how to effective access the individual receiving care in order to come up with determination of the appropriate drug therapy for the patient (Australian Prescriber, 2014).
In order to achieve these goals, the care givers must first be able to obtain any patients medical history. Research has shown that most medication errors occur during the time when a patient is transferred from one hospital to another, when an invalid if being discharged and or when an individual is being admitted (Barnsteiner, 2014). The caregiver is then supposed to know whichever the category the patient falls in and obtains their medical past, find out if he or she is allergic to any medicine find out if the patient had been on some other medications that can result in medical errors upon being swopped with a different type.
After this procedure the nurse should medicate the patients under his or her care and using the right medical reconciliation procedures. He or she should continue to monitor these patients for a given period, say a fortnight or month to find out if there are any medical errors that occurred due to poor medical reconciliation procedures. He or she should examine the nature of harm that occurred to the patient and find out if it was due to other causes or as a result of incorrect medical practices (Barnsteiner, 2014). The doctor will carry out a medical examination to find out the number of affected patients and come up with appropriate conclusion.
This evaluation must as well contain medical records of the number of patients observed, results obtained from each patient and the outcome of the process. after the care givers come up with the results, he or she might want to compare different outcomes from different patients. He or she must come up with an intervention plan to be used for each patient. The nurse might find out that different patients have different problems hence this calls for different intervention methods (Aspen, Wolcot & Bootman, 2006).
The other action plan that the doctor must have in mind while taking care of the patient on arrival, is to collect and analyze the previous records. Secondly the caregivers should come up with improvement alternatives for helping the patient to make his or her condition better, the nurse also needs to implement the chosen action plans and finally formulate measure for correcting any further errors. This helps in meeting the requirement of the patient upon arrival and before anything can be done (medication reconciliation, 2008).
The steps to take at discharge include finding out the post discharge medication routine, formulating discharge directives for the patient who use home medications, teaching the patient, and availing the medication list to the follow up care givers. For patients in ambulatory settings, the main steps include documenting a complete list of the current medications and then updating the list whenever medications are added or changed.
Intervention or Exposure
For the intervention or exposure level, the care giver should aim at observing the patient first. During the observation, he or she should come up with conclusive result or information that will enable the caregiver to move on to the next stage of Medicare plan (Aspen et al., 2006). After observation, the nurse may decide to either medicate/diagnose or treat the patient depending on the nature of his findings during the observation process. For example, if the nurse finds that the patient needs immediate medical attention, then he or she might proceed to treat the patient.
He can decide to award special treatment to the patient like putting him or her in support machines or intensive care if need be (Aspen et al., 2006). Upon finding out that the patient is not very ill, and then the nurse or doctor might decide to diagnose some medication for the patient. The prescribed medications should help alleviate the problems that the patient is facing without causing further medical errors if some already exist.
The comparison stage allows the doctor to come up with an alternative action plans. For example, the doctor or nurse might decide to give a different medication or decide whether the condition needs surgery or not. There might also be an alternative placebo techniques on the other hand some conditions might not need medication; instead the doctor might decide that the patient undergoes physiotherapy if he or she has sustained physical injuries.
If there are any medical errors, the doctor should first aim at identifying the existing medical mistakes and aim at solving them before proceeding in any way. For example, the doctor might find that there was an error in which the previous caregiver put the patient on medicine that he later reacted to. For instance, some patients do react negatively to prescription that contains elements such as sulfur and its compounds. It such cases, the patient is noted to have swollen skin areas, or the skin turns red (Jcaho, 2006). This problem can be rectified using anti histamine alongside other medical procedures that are available for use.
General studies show that the steps in medication reconciliation are seemingly straightforward.7 For a newly hospitalized patient, the steps include obtaining and verifying the patient’s medication history, documenting the patient’s medication history, writing orders for the hospital medication regimen, and creating a medication administration record.
Patients do suffer medical mishaps based on inaccurate or unavailability of their medical histories when they transfer from one hospital to the next, when they are admitted or when they are discharged. Medical reconciliation is a process that enables the caregiver to assess the patient past history in order to come up with effective intervention methods to help in correcting existing medical errors. This method also makes it possible for the doctor to formulate better methods of dealing with the patient till he or she is recovered from the hospital. Knowledge of medical reconciliation makes it easy for nurses and doctors to eliminate existing medical errors hence making patients life easier and free of harm from prescribed medicine. All care givers must have appropriate action plans to help hem help patients on arrival.
Aspen, P., Wolcot, J. & Bootman, L. (2006). Preventing Medication Errors:: Quality Chasm Series. New York, NY: National Academies Press
Australian Prescriber, (2014). The importance of medication reconciliation for patients and practitioners. Retrieved from http://www.australianprescriber.com/magazine/35/1/15/9
Barsteiner, J. (2014). Patient Safety and Quality: An Evidence-Based Handbook for Nurses. New York, NY: Routledge
Jcaho. (2006). The physician’s promise: protecting patients from harm. New York, NY: Joint Commission Resources
Medication Reconciliation: toolkit for implementing national patient safety goal 8. New York, NY: Joint Commission Resources