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Concerning the subject of this blog about medication reconciliation and CMS, we wanted to note that there are HEDIS measures that address or relate to medication reconciliation, a few of which overlap with CMS quality measures discussed above. We've already discussed medication reconciliation post-discharge . As NCQA notes about its MRP HEDIS measure, "Medication reconciliation is a critical piece of care coordination for all individuals who use prescription medications." Patients are living at home longer than ever before and managing multiple chronic illnesses. Many times, this means they are on several medications and require frequent titrations or drug regimen changes.
Gathering medication history for reconciliation is a cornerstone of excellent patient care. Gaps in medication history can delay optimal treatment, put patients at risk, and contribute to higher readmission rates. With MedHx℠ and SmartSuite™ automating your process, staff can save as much as 80% of the time they currently spend researching a patient’s medication – time that can be re-invested in diagnosis and care delivery. Medication reconciliation process design should center on the concept of a single list to document patient's current medications. This will be referred to as "one source of truth." This list should be shared and utilized by all physicians, nurses, pharmacists, and others caring for the patient.
What is Medication Reconciliation and Why is it Important?
The goal is to resolve any discrepancies, although the process isn’t straightforward and doesn’t have one unified framework. Variables to consider include patient expectations and goals. There is no electronic substitution for a thorough medication interview with patients and/or their caregivers to obtain and verify current medication regimens. If patients and/or caregivers are able to participate in an interview, clinicians should ask what medications patients are taking and how they are taking them to identify discrepancies or uncover potential medication problems. Medication Reconciliation upon Admission, Intra-Hospital Transfer, and Discharge in a Hospital with an Electronic Health Record. The following examples provide guidance on incorporating an electronic medication reconciliation process that includes "One Source of Truth" into the admission, transfer, and discharge workflow in order to make the right thing to do the easy thing to do.
The NP reviews the patient’s allergy list and renal function. However, she does have stage 4 chronic kidney disease, which means nitrofurantoin isn’t an option. Empowering patients to control their decisions may help them feel more comfortable and give you more insight into their medication regimen.
Quality and Disparities Report
Examples of electronic, paper-based, or hybrid (electronic plus paper-based) systems. This measure is currently used for CMS's ESRD Quality Incentive Program. 10.Miller LG, Matson CC, Rogers JC. Improving prescription documentation in the ambulatory setting.
Let’s take a step back and review some important concepts and definitions related to medication reconciliation for older adults. The American Geriatrics Society defines geriatric patients as those 65 years or older. They comprise 14% of the population and purchase 33% of prescription drugs. The AGS predicts that this group will increase to 25% of the population and 50% of the prescription drug consumers by 2040. Prompts to complete required steps for medication reconciliation are essential.
Medication Reconciliation for Patients Receiving Care at Dialysis Facilities
Depending on the physical barrier, we may be able to address it directly, or we may collaborate with PT or OT. Develop and teach strategies to improve adherence to medication routines. Identify and address communication, cognitive, and physical barriers to taking medications properly. I’m not competent to judge what to do about any interactions or warnings, and it’s not in my scope of license to make recommendations to my patient.
1.5 million avoidable ADEs occur every year, mostly in hospitals and long-term care facilities. 3 million older adults are living in nursing homes due to difficulty managing medication, costing $14 billion dollars yearly. Sign up to get free evidence-based articles, exclusive discounts, and insights from industry-leaders. If a patient has poor eyesight, ensure adequate lighting, have a magnifying glass available, or request assistance from a family member. If a patient has a hearing impairment, make sure they have their hearing aids in place, reduce background noise , and write out instructions. Speak clearly and slowly without shouting, and make good eye contact to show your interest; this also allows the patient to see your face and lips.
Before sharing sensitive information, make sure you're on a federal government site. Verify which meds patient has been taking since last medical encounter. Melissa is a Quality Assurance Nurse, professor, writer, and business owner. She has been a nurse for over 20 years and enjoys combining her nursing knowledge and passion for the written word. Before sharing sensitive information, make sure you’re on a federal government site.
Compare these meds against most recent MD ordered list of medications. As you get out your stethoscope and other necessary equipment, you ask Mrs. Jones to gather the pill bottles of all of her medications -prescription and nonprescription - that she is currently taking. She shuffles off to the next room and comes back holding a box of pills that date back to the Obama administration. Vaidya S. R., Shapiro J. S., Papa A. V., Kuperman G., Ali N., Check T., Lipton M.
She was admitted three days prior for a respiratory infection and exacerbation of her COPD. While in the hospital they started her on steroids, which increased her blood sugar. She tells you that she’s not even sure what medications she is supposed to be taking any more. Sockolow P. S., Bowles K. H., Adelsberger M. C., Chittams J. L., Liao C. Challenges and facilitators to adoption of a point-of-care electronic health record in home care. We know how to assess and treat communication and cognitive-communication impairments.
Enlist the support of primary care physicians and community pharmacists to encourage patients to carry and update their medication list at every encounter. Updating the patient's pre-admission medication list to reflect the patient's medication regimen upon discharge. This list may be integrated into Discharge Instructions and Discharge Summary .
Then I use my expertise to present that in a way that my patient can understand. In response to the Joint Commission National Patient Safety Goals, this form was developed to obtain a list of "medications as at home" prior to admission so that medications can be reconciled. It has been used extensively in all outpatient areas and on a medical/surgical unit. The form prompts the information collector for completeness, yet is organized for ease of use by nurse and physician. After completing Ms. Russo’s medication reconciliation, the NP considers what empiric antibiotic to prescribe for the dysuria, which is presumed to be a simple UTI. Ms. Russo hasn’t had a fever, flank pain, or any evidence of systemic illness.
They are looking for a Key Account Manager (m/w/d) for their Neurology range. All Transport Options, One Logistics Provider Marken has the flexibility to design the best supply chain solution for every customer, ensuring your clinical trial materials are delivered with the utmost care and efficiency. The only other item in the list above that might give an SLP pause is modifying the patient’s system to account for low vision or manual dexterity issues (#6). Involve patients with decision-making to improve self-efficacy and adherence.
Education programs need to include the research about medication reconciliation and the steps being put into place to make a safer system for patients. Potential for Interactions - Most electronic medical records have a built-in medication interaction checker. If you don’t have an electronic documentation system, you can use an online drug interaction checker like those found on Drugs.com or Rxlist.com. Exploring care transitions from patient, caregiver, and health-care provider perspectives. Adoption and use of electronic health records and mobile technology by home health and hospice care agencies.
But, when you know, you have five more patients to see and 50 miles of ground to cover - this process can get pushed to the side. Anyway, MIL reached a point where she was sleeping more than she was awake, and "awake" consisted of her being very groggy and not with-it mentally. Despite our urging, that didn't get addressed until she had to be hospitalized. That hospital was full, so they sent her to Hospital B, closest to our house. Multiple instances of Dr. A prescribing coumadin, Dr. B prescribing warfarin, and my MIL took both because my inlaws didn't have the medical sophistication to recognize a problem, and apparently their pharmacist never caught it.
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