Question

Medication reconciliation is an essential competency for the RN.

Explain the RN’s role in medication reconciliation and how it promotes patient safety.

Based on the QSEN Competencies, identify interventions the RN can implement to promote a culture of safety across the continuum of patient care.

Answer 1

1. Medication reconciliation is the formal process of obtaining and verifying a complete and accurate list of each patient's current medicines, matching the medicines the patients should be prescibed to those they are actually prescribed and making a new list and communicating the new list to the patient and caregivers. It is done to avoid errors such as omissions, duplications, dosing errors and drug interactions.

RN's Role

• Obtain the Best Possible Medication History (BPMH) of the patient's current regularly taken medications.
• Compare the BPMH with admission, transfer, discharge medication orders and communicate to the health team if there are any changes or discrepancies.
• Documentation of necessary changes made by the physician.
• Prevention of medication errors related to reconciling medications, such as failure to prescribe clinically important home medications while in hospital, incorrect doses or dosage forms, missed or duplicated doses, failure to clearly specify which home medications should be resumed and/or discontinued at home after discharge, and duplicate therapy at discharge.
• RN's are accountable for patient safety during medication administration, dispensing, medication storage, inventory management and disposal.
• They promote safe care, and contribute to a culture of safety within their practice environments, when involved in medication practices, such as client education,collaboration with client in making decisions, minimize risk of drug misuse and drug diversion, report medication errors, near misses, adverse reactions, in a timely manner, and collaborate in the development, implementation and evaluation of a safe support system of medication practices within the health care team.

2. According to QSEN (Quality and Safety Education for Nurses), the following interventions can help promote patient safety:

• Obtain complete medication history.
• Identify possible medication interactions and abnormal physical findings.
• Identify real/potential system failures, including medication adherence, patient records of medication history and adherence.
• Complete literature review related to medication reconciliation and safety.
• Draft/revise policy/procedures for medication reconciliation specific to the concerned unit.
• Complete patient care audits to document health care team compliance.
• Provide education to staff/patients/physicians related to medication reconciliation policy and procedures.
• Use technology and standardized practices effectively to support safety and quality.
• Use strategies effectively to reduce risk of harm to self and others.
• Use appropriate strategiesto reduce reliance on memory (i.e. use of checklists and forms).
• Engage in root cause analysis rather than blaming when errors occur.
• Use national patient safety resources to focus attention on safety in health care settings.
• Communicate observations or concerns related to hazards and errors to patients, families and the health care team.