I had the opportunity to spend a day at Abington Memorial Hospital last week as part of a special program held each year to recognize staff efforts to improve patient safety. I had a fascinating day attending various patient safety-related meetings and attending safety walk-arounds with members of the quality and safety team, a group of safety experts they’ve gathered to help set specific goals to protect patients. Many of these goals deal with medication safety.
At one of Abington’s safety committee meetings, we got into a discussion about the tremendous problems that nurses, doctors and pharmacists have in getting an accurate drug history from patients who come to the emergency room or are admitted. This is crucial information, not only to know what medicines need to be continued during a patient’s hospitalization, but also whether unwanted side effects are occurring and whether or not a drug dosing error, duplication, or omission might be the cause of a patient’s symptoms. Problems can also be identified that are due to drug allergies, and interactions between drugs, foods or herbal products. Problems you might be having with optimizing drug doses and eliminating the drug from your body also need to be considered.
During my visit we got into a discussion about the need for patients to maintain and carry with them a list of all their medicines, as well as give a copy to a family member or other person they can trust for emergencies. (Go here for more information, safety tips and a form you can use). It was mentioned how people sometimes forget to list eye drops, inhalers, medicine patches, and birth control pills. Also mentioned was that many people do not consider vitamins, herbal remedies, homeopathic medications, and even aspirin or other OTC drugs as medicines. All too often this information, while just as important, is left out, so list these items too.
The team at Abington couldn’t emphasize enough how important medication reconciliation is, yet how frequently it can’t be carried out accurately because patients don’t come prepared. Come to think of it, neither my wife nor I have such a list to hand over to a care provider! It’s unforgiveable, and something that will change immediately thanks to the reminder I got at Abington.
If you do happen to find yourself in a situation where you need to provide information about your medications and you don’t keep a list or have your medications with you, you’ll be less likely to forget about a medicine that you take at home if you think about the doctors you visit and the medicines each one has prescribed for you. Then think about your health conditions and the over-the-counter and prescription medicines you take for each one. Finally, think about the vitamins and herbal products you take to stay healthy. But again, it’s much better to maintain a list and have it with you in a wallet, briefcase or handbag!
During a hospitalization, ask for a copy of your medicine record. This lists all the medicines that you are getting. Check it for accuracy. If you move to a different location in the hospital, check your medicine record again because it’s part of the routine that doctors must rewrite your medication orders when you are transferred. If you are not well enough to do this, ask a friend or relative to help. Anything that’s unexpected, including a discontinued item that you didn’t know about, should be questioned.
A few years ago, the Joint Commission, which develops standards for healthcare quality and safety and accredits approximately 80% of US hospitals to assure they meet these standards, made it a national goal for hospitals to obtain an accurate list of medicines the patient has been taking at home. Called “medication reconciliation,” the idea is to have the doctor look at this list when prescribing medicines and compare the list of medicines taken at home with the medicines prescribed in the hospital to make sure there are no mistakes and that everything is appropriate for you given your present clinical situation.
Hospitals and other healthcare organizations accredited by the Joint Commission must demonstrate that they’re properly addressing the medication reconciliation requirement beginning July 1, 2011. To learn more about the requirement, search the Joint Commission's website here.
As part of medication reconciliation, when you are ready to leave the hospital, a nurse or doctor must finalize an updated medication list to add any new medicines and also cross off the list any medicines that you were previously taking but should immediately stop. When you visit your doctor and pharmacist after being hospitalized, always take this new list of medicines with you so they can update their records.
For more on ISMP’s consumer website, go www.consumermedsafety.org.