Hospital Pharmacy Regulation Report

Transcription

1 Vol. 3 No. 10 October 2005 Hospital Pharmacy Regulation Report INSIDE Top five problematic standards Check out the five most-cited standards so far in 2005 on p. 5. Fentanyl patch safety Get expert tips to improve the safety of pain patches on p. 6. Standard of the month Pharmacists provide three ways to handle a patient s home medications during a hospital stay on p. 7. Get a sample receipt on p. 9. Book excerpt A nurse leader from Milford (MA) Regional Medical Center provides three tips to comply with the JCAHO medication reconciliation goal on p. 10. Get a sample policy on p. 11. Katrina provides lessons for hospitals Training, communication critical for disaster planning Caring for patients at Charity Hospital in New Orleans required resilience after Hurricane Katrina battered the Gulf Coast. The water was just pouring in, Ruth Berggren, MD, told television news network CNN on August 31. We were dodging water, ceiling tiles. Soon after one of the deadliest hurricanes in American history made landfall southeast of New Two formerly proposed National Patient Safety Goals may make a comeback for 2007, a JCAHO official said September 1. Orleans on August 29, some of the levees protecting the city from Lake Pontchartrain and the Mississippi River failed, allowing water to flood the city. The hurricane and ensuing flood waters cut power and drinking water. The lack of power and drinking water and the evacuation of a major American city may cause hospitals to revisit their disaster plans in the coming months. Pharmacists should help JCAHO reveals potential 2007 goals Bar coding, high-risk med safety back on the table > p. 2 for implementation in 2006, but the commission held off, citing the need to evaluate the proposal more. The compliance deadline for the JCAHO s medication reconciliation goal is right around the corner. Don t miss the November HPRR, which will give you plenty of tips in a special report. FOR PERMISSION TO REPRODUCE PART OR ALL OF THIS NEWSLETTER FOR EXTERNAL DISTRIBUTION OR USE IN EDUCATIONAL PACKETS, PLEASE CONTACT THE COPYRIGHT CLEARANCE CENTER AT OR 978/ Using technology such as bar coding to identify patients and improving the safety of anticoagulants, insulin, and narcotics are two topics the JCAHO s Sentinel Event Advisory group considered during a mid-september meeting, said Richard Croteau, MD, the JCAHO executive director for strategic initiatives, during the Hospital Executive Briefings in Rosemont, IL. The JCAHO tabled bar coding in 2004 after receiving more than 1,000 comments from the field. The anticoagulants, insulin, and narcotics goal had been proposed Depending on the outcome of the Sentinel Event Advisory group meeting, which was unknown at press time, the two proposals could make a field-review list that would come out in early Bar coding goal tweaked The bar coding goal proposed in 2004 would have required organizations to have a system in place to identify patients and their medications by 2007, a timeline that drew criticism from the field for being unrealistic. The goal this time around would not necessarily require hospitals to > p. 4

2 Katrina lessons < p. 1 lead that planning to ensure that facilities have adequate medications during an emergency, experts say. Standards played out The JCAHO has numerous standards governing emergency preparedness, including EC.2.10 The hospital identifies security risks EC.4.10 The hospital addresses emergency management EC.4.20 The hospital conducts emergency drills EC.7.20 The hospital provides an emergency electrical source But standards became an afterthought soon after Hurricane Katrina moved out of New Orleans French Quarter. After the power went out, many hospitals operated on backup power. But when Governor Kathleen Blanco ordered an evacuation of the city on August 30, officials had to scramble to move patients and treat those in need of dialysis and other lifesaving procedures requiring water and electricity. Evacuations of some hospitals took days to complete, according to media reports. We didn t expect what happened in New Orleans, said Darlene Christiansen, RN, LNHA, MBA, director of the Standards Interpretation Group and Office of Quality Monitoring at the JCAHO, during the Hospital Executive Briefings conference in Rosemont, IL, on September 1. We will work with them to help them improve their situation. The JCAHO Standards Interpretation Group will discuss environment of care issues with organizations in the wake of Katrina, commission spokesperson Mark Forstneger says. That office may be reached at 630/ The commission suspended survey activity in the affected areas, including New Orleans and Biloxi, MS, Forstneger says. The impact of Hurricane Katrina will last longer than a few weeks, and the Joint Commission is prepared to accommodate that reality for organizations in affected areas, says Forstneger. Start planning in advance If a major hurricane or other disaster gives hospitals time to prepare, organizations should work with their vendors to stockpile critical medications, says David Teeter, PharmD, an emergency management consultant and pharmacist at Wishard Hospital in Indianapolis. Look at what you use for patients who are likely to stay there [during an emergency], Teeter says. That would be your immediate need. Organizations should utilize their drug-procurement database to identify critical medications they may need for their intensive care units (ICU) and consider how they will keep medications that need refrigeration cool, including using backup generators or ice, Teeter said. Also consider temperature controls and alternative storage space for shelf stock. If the air conditioning fails, medications that must be kept at room temperature will bake in heat and humidity, Teeter says. Alternate storage spaces should include areas on upper floors, which can keep emergency supplies and medications away from floodwaters, Teeter says. The Southeast Louisiana Hurricane Evacuation and Sheltering Plan revised by the state in January 2000 requires hospitals to take emergency precautions such as placing emergency supplies and equipment on upper floors. Those supplies include water and backup generators, according to the report. Cover all supply lines Maintaining a redundancy of vendors should help pharmacies obtain the medications necessary to function during a disaster, Teeter says. That re- Page HCPro, Inc.

3 dundancy would include working with a primary drug vendor and a secondary supplier, he says. Through the hospital s emergency operations center, the pharmacy can request emergency medications from the local and state governments up to the federal level to augment existing supplies, Teeter says. But Teeter cautions that all disasters start locally and adds that relief aid from state and federal agencies takes time to arrive, placing an added emphasis on local hospital preparedness. They could be on their own or receive little help for hours or days, Teeter says of local hospitals. Federal and state assets can be positioned in disasters with warning periods such as this. But it still takes time to get to the impacted areas and deliver services. For example, medications and supplies from the federal government may not arrive until a few days after the disaster, Teeter says, which was the situation on the Gulf Coast after Katrina hit. Prepare for strained resources A lack of communication and security hampered evacuation efforts, an ambulance official told CNN on August 31. A massive evacuation effort to move nearly 20,000 refugees from the Louisiana Superdome to the Astrodome in Houston was suspended temporarily September 1 when shots were fired at HPRR Subscriber Services Coupon Start my subscription to HPRR immediately. Options: No. of issues Cost Shipping Total Print 12 issues $299 (HPRRP) $24.00 Electronic 12 issues $299 (HPRRE) N/A Print & Electronic 12 issues of each $374 (HPRRPE) $24.00 Order online at Sales tax (see tax information below)* Be sure to enter source code N0001 at checkout! Grand total For discount bulk rates, call toll-free at 888/ *Tax Information Please include applicable sales tax. Electronic subscriptions are exempt. States that tax products and shipping and handling: CA, IL, MA, MD, NJ, VA, VT, FL, CT, GA, IN, MI, NC, NY, OH, PA, SC, TN, TX, WI. States that tax products only: AZ. Please include $27.00 for shipping to AK, HI, or PR. a military helicopter. Pharmacists might be required to function in other roles to aid in evacuations or treatments, Teeter says. But managers will need to make sure they have adequate staff and rested staff to operate effectively. Even though you need everyone at the start, the manager is going to have to step back and say, I m going to have to allow a certain number of people to go back to their rooms and rest, Teeter says. Regulators such as the JCAHO may want hospitals to develop more in-depth drill scenarios after seeing the extreme challenges hospitals faced in New Orleans and the Gulf region, says Mark Cavanaugh, CFPS, fire marshal at University of Rochester (NY) Strong Memorial Hospital. JCAHO officials may ask for drills that stress a hospital system, which the conditions on the Gulf Coast clearly did in real-life evacuations. Forstneger says it is too soon to tell whether the commission will revise any emergency-related standards. The commission has drafted emergency drill standards but has yet to approve them. But along with better drills comes the need to dedicate resources for such training, possibly through a national commitment, Cavanaugh says. > p. 4 Your source code: N0001 Name Title Organization Address City State ZIP Phone Fax address (Required for electronic subscriptions) Payment enclosed. Please bill me. Please bill my organization using PO # Charge my: AmEx MasterCard VISA Signature (Required for authorization) Card # (Your credit card bill will reflect a charge to HCPro, the publisher of HPRR.) Expires Mail to: HCPro, P.O. Box 1168, Marblehead, MA Tel: 800/ Fax: 800/ customerservice@hcpro.com Web: HCPro, Inc. Page 3

4 Katrina lessons < p. 3 It s common to hear that hospitals couldn t convince a local fire department or ambulance company to participate in a drill, which decreases the effectiveness of this training, he says. Security needed to protect supplies News organizations reported in the days after Hurricane Katrina that looters attempted to break into Children s Hospital, placing an added emphasis on security issues. JCAHO standard EC.2.10 requires hospitals to identify security risks, and in the event of a disaster, hospital staff should pay attention to possible vulnerabilities, including the pharmacy, Teeter says. Pharmacists need to keep their awareness up, Teeter says. They need to look around and see who s behind them when they walk through that [pharmacy] door. Disaster plans should include a lockdown or limitedaccess plan, in which entry points to the facility are limited to one or two doors. Security forces can then focus their efforts on those entry points, Teeter says. Practice communication strategies Identifying a chain of command in a disaster is critical to maintaining order at a hospital during chaos, Christiansen said. Hospitals also need to identify backup communication methods in case the phones go out. Communication plans must be in place and practiced to ensure that they work during a disaster, Teeter says. Cell phones may not work, but satellite phones and ham radios might, he says. Pay phones may also provide another means of communication if some landlines still work, he says. Practice before something happens, Teeter says. Usually the first or second thing talked about [after a disaster] is communication goals < p. 1 implement bar code systems by a certain date, Croteau said. The proposed requirement may allow hospitals time to think about how they would use the technology and start planning for a system without setting an implementation deadline, he said. The goal may also consider other track-and-trace technologies, such as radio frequency identification, to identify patients, Croteau said. If hospitals currently use bar coding, surveyors will want to learn about the system and will ask questions about how staff use it to ensure patients receive the correct medications and treatments, said Patricia Adamski, RN, MS, MBA, senior associate director for standards interpretation. High-risk medication checks needed The JCAHO in 2005 proposed to phase in a goal that would improve the safety of using high-risk medications. The commission would have required hospitals to take steps to improve safety with anticoagulants in 2006, phasing in insulin and narcotic safety in subsequent years, the accreditor said in February. It was unclear at press time how the goal would differ in A source close to the JCAHO said the goal probably would require mechanisms for double checks and monitoring patients for signs of distress, including respiratory depression with narcotics. Although numerous JCAHO standards cover medication safety, placing high-risk medications in the goals would create an added emphasis, Croteau said. Page HCPro, Inc.

5 Everyone is much more tuned into the Patient Safety Goals than to many of the standards, Croteau said. We get a lot of spotlight on the safety goals. No unapproved abbreviation changes Croteau also said there would be no additions to the unapproved abbreviations list in 2006, and it will probably remain the same in 2007 as well. We re not anticipating any major changes, he said. The National Summit on Medical Abbreviations in November 2004 recommended the JCAHO add the symbols > and < to the unapproved list, but that won t happen anytime soon, Croteau said. The most likely move would be to ban drug-name abbreviations, which could come in 2007 in the form of an goal or standard, Croteau said. Abbreviation clarification not official Croteau also reiterated the JCAHO s stance on pharmacists and nurses clarifying an order with an unapproved abbreviation. Now, those staff must contact a prescriber to clarify an order that contains one of the 2005 problematic standards The JCAHO standard regulating unapproved abbreviations again topped the list of five most problematic standards for hospitals surveyed in 2005, according to data from the JCAHO released during the Hospital Executive Briefings in Rosemont, IL, on September 1. Other standards include the following (the percentages are requirements for improvement among surveyed hospitals): IM.3.10 processes to effectively manage information (44%) MM.2.20 medications are safely stored (38%) PC operative or other procedures are planned (27%) EC.5.20 facilities comply with the Life Safety Code (16%) MM.3.20 medication orders are written clearly and transcribed correctly (15%) nine abbreviations, he said. Surveyor Darryl Rich, PharmD, MBA, said in June during the American Society of Health-System Pharmacists Summer Meeting in Boston that the commission would soon allow pharmacists and nurses to fill an order containing an unapproved abbreviation if they could understand what the order meant by using their best clinical judgment. However, the JCAHO has not yet approved that position, Croteau said. The commission is evaluating possible legal implications, including allowing pharmacists and nurses to operate outside their scope of practice by interpreting orders, he said. But the JCAHO does not believe pharmacists and nurses should police physicians when it comes to orders. We are not making nurses and pharmacists responsible for changing the behavior of physicians, Croteau said. The burden is on the medical staff. Editor s note: This article was adapted from a breaking news that went out to subscribers September 2. If you did not receive the , contact customer service at 800/ to update your contact information. Illustration by Dave Harbaugh JCAHO s here. They selected you as a target for their pilot survey. The questions are printed on velcro darts HCPro, Inc. Page 5

6 Staff training corner FDA: Be on the lookout for pain-patch errors A nurse walks into a patient s room to apply the next dose of a fentanyl pain patch. The nurse doesn t see another patch on the patient s body, so the second dose is administered. However, the patient is already wearing a patch, but because it is transparent, the nurse cannot see it. That mistake could result in a fatal overdose, and the Institute for Safe Medication Practices (ISMP) has received numerous error reports involving similar cases. Pharmacists can play a vital role in pain-patch safety, from educating nurses about properly applying a patch to working with patients on safe use and storage, says ISMP President Michael Cohen, RPh, MS, ScD. Error reports the ISMP and Pennsylvania s errorreporting network have received more than 100 since June 2004 led the FDA to issue a public health advisory on July 15, urging hospitals to improve the safety of using fentanyl patches, often sold under the brand name Duragesic. One of the good things we can do is make sure patients get adequate education about the patch, Cohen says. To have a patient come in and get a box of these Duragesic patches and not get education is abysmal to me. Locate patch placement Cohen notes that many hospital pharmacists may not have interactions with patients, limiting their education efforts. Some pharmacists may be involved with admission or discharge interviews, so they could provide some instruction then, he says. But the primary activity should be to educate nursing staff about using pain patches, Cohen says, which includes making nurses aware to look for a patch already on a patient s body. The medication administration record (MAR) could be a useful tool. The document notes when nurses must give a medication, the dose, and the route. Staff could easily note on the MAR the patch location on the patient s body so nurses know to look before placing a second patch, Cohen says. Monitor dosages Pharmacists can also educate physicians and monitor prescribing practices, Cohen says. For example, if a pharmacist notices that a physician prescribes 75 mg of fentanyl, the pharmacist should be certain that the patient has already received the drug at a lower dose without pain control. Patients new to the fentanyl patch must have already received and tolerated oral or injectable narcotics. If not, the pharmacist must call the physician and explain why a lower dose (e.g., a 25 mg patch) is necessary, Cohen says. Physicians also need to know how to properly report errors with fentanyl patches, Cohen adds. Educate patients about use Patient education is critical, especially if a patient will continue using the patches at home. The ISMP noted in a press release an error involving a 77-year-old woman who died in March after applying a patch and then placing a heating pad over it, which can increase the drug-absorption rate. She also may have applied a second patch without removing the first, the ISMP said. The patches should be dispensed with information about use, storage, and disposal, Cohen says. Questions? Comments? Ideas? Contact Managing Editor Matt Bashalany Telephone: 781/ , Ext mbashalany@hcpro.com Page HCPro, Inc.

7 JCAHO standard of the month MM.2.40 Prescription for success: Tips to handle home meds Knowing how your hospital controls a patient s home medications will help when a patient brings drugs into the facility and needs to use them. We would rather not use a patient s home medications in the hospital, says David Kellogg, DPh, MS, pharmacy director at Tennessee Christian Medical Center in Madison, TN. We don t know how they are stored or where [the patients got them]. But in some instances, such as during drug shortages or in the case of expensive HIV or other drugs that the pharmacy may not stock, using a patient s own medications is inevitable. JCAHO standard MM.2.40 requires hospitals to create a process to safely manage medications patients or their families bring to the facility. Take control The Tennessee Christian pharmacy controls all patient prescriptions, meaning that patients do not keep medications in their rooms, Kellogg says. Pharmacists handle the dispensing of all medications, including the patient s own from home, he says. Medications are arranged by patient s last name and placed in file cabinets in one area of the pharmacy. The drugs are considered to be in a secure area because the pharmacy is locked at all times, Kellogg says. Nurses at Reedsburg (WI) Area Medical Center collect all patient medications if they must be used, says Linda Chickering, RPh, the clinical pharmacy director. The nurse tags and places them in a secure area, which may include the patient s bedside in most units, she says. If medications are kept at the bedside, nurses place them in a locked drawer and then take the key to maintain security, Chickering says. The hospital s small intensive care unit does not have locked drawers in patient rooms, so staff place those medications in the hospital s Pyxis tower. Patient medications requiring refrigeration are placed in the Pyxis refrigerators, Chickering says. Each patient room has its own medication bin in the Pyxis machine for any drugs brought from home, she says. Know what they are Pharmacists must verify every medication a patient brings in from home. Kellogg notes instances in which some patients have brought illicit street drugs in prescription bottles into the hospital in an attempt to use them while in the facility. After pharmacists visually verify the drug, they place their initials and date on the bottle sticker, and they must also obtain an order for the patient s medication from the physician for it to be used in the > p. 8 Standard MM.2.40 at a glance The organization establishes a process to safely manage medications patients or their families bring to the hospital. Requirements for MM.2.40 The organization creates a policy addressing the use of medications a patient or family members bring to the hospital, including the following: When such medications may be used or administered A process for identifying the medication and evaluating its integrity A process to inform the prescriber and patient if bringing medications into the hospital is not allowed 2005 HCPro, Inc. Page 7

8 Home meds < p. 7 hospital, Kellogg says. chart, and gives another copy to the patient, Kellogg says. Technology also helps Reedsburg staff identify and track a patient s own drugs. We are using bar-code verification now, so we also print out a bar code of the medication order and use that sticker to scan medications to verify administration of a patient s own medication, Chickering says. Verifying and tracking a patient s home medications can also help the hospital comply with the JCAHO National Patient Safety Goal requiring organizations to obtain a complete and accurate medication list and reconcile it across the continuum of care. When the patient is discharged, the nurse takes the forms to the pharmacy and exchanges them for the patient s medications, Kellogg says. See p. 9 for a sample of the form. Physicians may sometimes alter a patient s therapy during the course of the hospital stay, rendering the home medications obsolete, Kellogg says. In those cases, the physician will write an order to destroy the drugs, and the pharmacy will handle that task. Otherwise, the pharmacy must return the drugs to the patient upon discharge. That goal takes effect January 1, Get a receipt A three-part form helps Tennessee Christian staff document receipt of a patient s home medications, says Kellogg. When a patient brings prescriptions from home, nursing staff collect them and sign the form, send the medications to the pharmacy, and then a pharmacist signs the form. The medications are legally still theirs, Kellogg says. They have to get them back. OCT./NOV. Upcoming events The patient or a family member must also sign the receipt. The pharmacist staples a copy of the form to the bag with the medications, sends one copy to the patient s Audioconferences: October 21 ED On-Call Struggle (MS102105) Medication-reconciliation deadline looms Are your staff ready to handle the JCAHO s medication reconciliation requirement? If not, HCPro offers your best hope for meeting the deadline. Check out the video Medication Reconciliation: Communication Strategies for Staff Compliance and get the essential compliance tips and strategies. Visit for more information. October 27 Conducting RCAs (Q102705) November 15 OIG Work plan for Hospitals (P111505) November 18 SBAR Techniques and Strategies (Q111805) Call customer service at 800/ to register or visit for more information. Page HCPro, Inc.

9 Sample receipt for medications brought from home See the list of patient medications on the nursing admission assessment. All medications brought to the hospital from home MUST be picked up from the PHARMACY DEPART- MENT at the time of discharge from the hospital. Medications left at the hospital more than 10 days after discharge will be subject to disposal. Patient or representative Date Nursing representative Date Pharmacy representative Date ********************************************************************************************* (White) First copy: Attach to the chart (Yellow) Second copy: Staple to bag containing medications (Pink) Third copy: Give to patient or representative ******************************************************************************************** Returned signature Date or Destroyed signature Witness signature Date Source: Tennessee Christian Medical Center, Madison. Reprinted with permission HCPro, Inc. Page 9

10 Three tips for successful med reconciliation training Editor s note: The following is an excerpt from the book Medication Reconciliation: Practical Strategies and Tools for JCAHO Compliance, written by Maureen Gibbs, RN, BSN, and published by HCPro, Inc. For more information or to order, visit www. hcmarketplace.com or call 800/ As you roll out your medication reconciliation process, staff will need to understand the definition of medication reconciliation and demonstrate how the process occurs across the continuum of care, including admission, transfer, and discharge. A successful medication reconciliation training program will likely include the following information: 1. Clear definition of medication reconciliation 2. Real-life examples of medication reconciliation s importance 3. Simple step-by-step outline of the facility s medication reconciliation process 1. Clear definition of medication reconciliation. Before you begin training staff on the steps of your specific process, be sure that staff thoroughly understand the basic definition of medication reconciliation. Milford (MA) Regional Medical Center leaders began by teaching staff the following definition of medication reconciliation: Medication reconciliation is the process that compares the patient s current list of medications against the physician s admission, discharge, or transfer orders. Because medication reconciliation is a National Safety Patient Goal and surveyed under tracer methodology, all staff not just those at the bedside must be able to discuss the process and communicate your hospital s definition of medication reconciliation to JCAHO surveyors. Those directly involved in the process, of course, must demonstrate to the JCAHO how medication reconciliation occurs at your facility. Through your training efforts, medication reconciliation should become a buzzword. Take advantage of opportunities to talk about it. Nurse managers should keep medication reconciliation on the agenda of every staff meeting and use internal hospital newsletters, intranet sites, and (if available) to publish information about this topic. Physician champions also can address medication reconciliation during medical staff meetings. Your team leader should seize every opportunity to discuss medication reconciliation, whether at the unit level or through hospitalwide committee participation. Present results from chart audits and monitoring during committee meetings. Attend other departments meetings to share information about medication reconciliation. See a sample policy on p. 11. Although your policy will differ depending on your facility and your process, any policy should outline the following: The person accountable and responsible for medication reconciliation How to use the reconciliation form Definitions of terms Time frame for reconciliation to occur 2. Real-life examples of medication reconciliation s importance. The success of any medication reconciliation process depends on buy-in from both leaders and staff. Training is much more effective if your staff understand why medication reconciliation is so important. For example, posting real-life examples for staff to see how medication reconciliation prevented errors will help them understand the goal s importance. 3. Simple step-by-step outline of the facility s medication reconciliation process. Orientation to medication reconciliation at Milford Regional also included a poster board presentation about the How-to of admission and discharge reconciliation. As you educate your staff about the > p. 12 Page HCPro, Inc.

11 Sample medication reconciliation policy and procedure Effective date: 09/28/05 Distribution: Nursing, pharmacy Originating dept./committee: Performance improvement team Contributing dept./committee(s): Director, pharmacy Medical staff: Vice president medical affairs Senior management: Vice president patient care services Section of manual: PT Signature: Signature: Signature: Signature: Policy: Medication reconciliation is the process that compares a patient s best known list of current medications including over the counter and herbals against the physician s admission, transfer, or discharge orders. Discrepancies are brought to the attention of the physician, and, if appropriate, changes are made to the orders. Procedure: The inpatient database includes the medication reconciliation form. The medication reconciliation form is a twosided document. Instructions for use are located on the back side of the form. Patients entering through the emergency department represent the majority of admitted patients. A medication history will be obtained from the patient/family/referring facility by the admitting nurse. The registered nurse (RN) admitting the patient to the inpatient setting will document the medication history on the medication reconciliation form. This includes drug name, dose, schedule, the last time the medication was taken, amount of noncompliance, and information source. The admitting RN will address any discrepancies between the medication history and the physician s admitting orders with the MD. The medication reconciliation form will be kept in front of the physician order sheets in the medical record. The nurse who signs off on the transcription of the orders will document any additions, changes, or deletions to the patients medication regime that occur during hospitalization on the medication reconciliation form including recurring daily doses and excluding one-time doses. To ensure accuracy in transcription of medication orders, the night nurse is responsible for the final 24-hour chart/medication check. Patients admitted postoperatively through preadmission testing will have medication history documented on the medication reconciliation form during their preadmission visit. The medication reconciliation form will be placed in the patient chart and will be available with the chart on the day of surgery. The nurse who receives the patient postoperatively from the postanesthesia care unit (PACU) will reconcile postop orders with the medication history upon transfer from the PACU to the inpatient unit. He or she will notify the attending physician of any discrepancies and document the outcome on the medication reconciliation form. The admitting RN in maternity and the admitting RN for direct admissions to the inpatient units will reconcile the medication history with the admitting orders. He or she will address discrepancies with the ordering physician and document on the medication reconciliation form. The transfer component of medication reconciliation occurs on those patients who are transferred into or out of the intensive care unit (ICU) from/to an inpatient bed. All patients transferred into or out of the ICU must have their order set rewritten. The nurse completes the transfer portion of medication reconciliation. He or she notifies the prescriber of any discrepancies and document the outcome on the medication reconciliation form. The discharging MD orders the list of discharge medications upon the patient s discharge from the facility. The nurse discharging the patient brings any discrepancies to the attention of the discharging MD, and any changes are made to the medication reconciliation form. All active medications on the medication reconciliation form must be addressed by the RN with the physician. Medication discrepancies will be reconciled within a 12-hour time frame. Source: Medication Reconciliation: Practical Strategies and Tools for JCAHO Compliance. 2005, HCPro, Inc HCPro, Inc. Page 11

12 Med reconciliation < p. 10 step-by-step process of medication reconciliation, consider what challenges or issues may come up within each step, and offer your staff strategies for dealing with them. For example, one common challenge early in the medication reconciliation process is acquiring an accurate list of the patient s home medications. To help the patient provide all necessary medication information, ask him or her specific questions about over-the-counter medications, herbal supplements, and eye, ear, or nose drops. Providing a patient with a wallet-sized medication card at discharge can save the hospital admission time when the patient returns for a subsequent visit if a patient can provide a card to the nurse, then he or she does not have to rely on memory. Blank medication cards can be provided to community groups, primary care physicians (PCP) offices, and clinics as a precautionary measure. Hospitals also should develop techniques to acquire medication lists from individuals other than the patient. Family members can provide medication information, bring the patient s prescription bottles, or take the medication list off of the refrigerator door. The patient s PCP can also provide a list of current medications, although privacy regulations require permission for this request. Also check your facility s record for medication information, especially if the patient was recently discharged from your facility. Finally, call the pharmacy where the patient s prescriptions are filled for information (note that the facility must obtain permission to do this as well). To make the process of contacting pharmacies more efficient, the medication reconciliation form developed at Milford Regional has a space for the name of the patient s pharmacy. Other facilities have added to their form a list of local pharmacies and their phone numbers. Hospital Pharmacy Regulation Report Editorial Advisory Board David Benjamin, PhD Clinical Pharmacologist/Toxicologist Chestnut Hill, MA Diane Cousins, RPh Vice president, Center for the Advancement of Patient Safety U.S. Pharmacopeia Rockville, MD Michael Hoying, RPh, MS Pharmacy Director Fairview and Lutheran Hospitals Cleveland, OH James O Donnell, PharmD, MS Associate Professor of Pharmacy Rush University Medical Center Chicago, IL William Sarraille, Esq. Sidley Austin Brown & Wood LLP Washington, DC Donna Soflin, PharmD Director of Pharmacy Tri-County Hospital Lexington, NE Douglas Wong, PharmD Pharmacy Healthcare Solutions AmerisourceBergen Corporation Fort Washington, PA We want to hear from you... For news and story ideas: Contact Managing Editor Matt Bashalany Phone: 781/ , Ext Mail: 200 Hoods Lane, Marblehead, MA mbashalany@hcpro.com Fax: 781/ Group Publisher: Paul Amos Senior Managing Editor: Jay Kumar Online resources: Web site: Access to past issues: Subscriber services and back issues: New subscriptions, renewals, changes of address, back issues, billing questions, or permission to reproduce any part of Hospital Pharmacy Regulation Report, please call customer service at 800/ Hospital Pharmacy Regulation Report is published monthly by HCPro, Inc., 200 Hoods Lane, P.O. Box 1168, Marblehead, MA Subscription rate: $299/year or $538/two years Copyright 2005 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc. or the Copyright Clearance Center at 978/ Please notify us immediately if you have received an unauthorized copy. For editorial comments or questions, call 781/ or fax 781/ For renewal or subscription information, call customer service at 800/ , fax 800/ , or customerservice@hcpro.com. Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the Marketing Department at the address above. Opinions expressed are not necessarily those of HPRR. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. Page HCPro, Inc.