Question

Initial Discussion Post: 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. Case Western Reserve University. (2014). QSEN Competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/ Base your initial post on your readings and research of this topic. Your initial post must contain a minimum of 250 words. References, citations, and repeating the question do not count towards the 250 word minimum.

Answer 1

The overall goal for the Quality and Safety Education for Nurses (QSEN) project is to meet the challenge of preparing future nurses who will have the knowledge, skills and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.

'Medication' means something that treats the symptoms of disease and 'reconciliation' means the act of compliance or agreement. Together these two words, medication reconciliation, represent a process by which a complete list of each patient’s current medications is obtained every time the patient enters the health care organization and is then communicated to subsequent providers in or out of the same health care organization.

The goal of medication reconciliation is to prevent adverse drug events that could occur by allergic reactions, omissions, substitutions, and/or duplications. It is a necessary, yet simple, way of assessing what medications patients are currently taking.

Medication reconciliation is necessary because a patient’s medications can change at any point in time for any number of reasons (such as a newly diagnosed disease process, an age-related issue, an acute condition, a worsening chronic situation, a short-term need for antibiotics, patient altering medication regimens, or adding nonprescription, herbal, or other products to their regimen, or elective or emergency surgery) and because those medications can precipitate one or more allergic reactions, food and drug interactions, and/or drug to drug interactions. Medication reconciliation is an extremely important process that needs to take place every time a patient is involved with any health care system.

QSEN standards
1 Patient-Centered Care
2 Teamwork and Collaboration
3 Evidence-based Practice (EBP)
4 Quality Improvement (QI)
5 Safety
6 Informatics

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

Medication reconciliation is a process designed to improve communication and promote teamwork. This has the objectives of preventing medication errors associated with the handover of care and maintaining continuity of care. It is described as the formal process of obtaining, verifying and documenting an accurate list of a patient's current medicines on admission and comparing this list to the admission, transfer and discharge orders, to identify and resolve discrepancies.

The Nurses has to follow the below mentioned measures in medication reconcillation:

The best possible medication history
A 'best possible medication history' is the cornerstone of the medication reconciliation process. It is described as a comprehensive drug history obtained by a clinician that includes a thorough history of all regular medicines used, including non-prescription and complementary medicines, and is verified by more than one source. A structured process for taking the history, that involves the patient or carer or family, using a checklist to guide the interview, and that verifies the history with information from a number of different sources, provides the best assessment of the drugs a patient takes at home.
Sources used to obtain a comprehensive history. Patients being admitted to hospital should be advised to take their medicines containers and current medicines list.
Ideally the best possible medication history is completed before any drugs are ordered and is used when the medication chart is written up. For unplanned admissions the history is usually completed after the initial medication orders have been written and is used to reconcile the orders.
In the community the general practitioner can refer to the community pharmacy for a list of dispensed medicines or request a Home Medicines Review to determine the medicines currently taken. This best possible medication history should be reconciled with the current medication list in the patient's record and their condition.

Standardised reconciling form
A standardised form for recording the best possible medication history and reconciling any discrepancies is essential for effective medication reconciliation. Whether electronic or paper based, the form should be kept in a consistent, highly visible position in the patient's notes and be easily accessible by all clinicians when writing medication orders and reviewing the patient.

Electronic solutions
Computerised systems (e-prescribing) may prevent many of the medication errors that occur at transfers of care but these systems are not without their problems. They still require someone to enter an accurate list of drugs and allergies.Medication lists in electronic records can lag behind prescription changes and be incomplete. For example, they may only contain the medicines prescribed in a particular system, and not include non-prescription products or medicines prescribed by other practitioners. Outdated, unverified or inaccurate information may be transferred indefinitely when using copy-and-paste facilities, so reconciliation is still required.

Reconciling medicines
Medicines should be reconciled as soon as possible, at least within 24 hours of a patient's admission to hospital or earlier for high risk drugs. This involves a clinician comparing the history against the medication orders at admission, transfer or discharge to identify any variances and bring them to the attention of the prescriber, taking into consideration the patient's clinical condition. Any changes to orders are documented. Whoever performs the task should be trained and competent in the process.
In the community, medication reconciliation should occur on receipt of information about the discharge medication. The general practitioner can compare the medication history in the patient's notes with the discharge medicines list provided by the hospital, reconciling any differences and updating the patient's record. Similarly when changes are made to a patient's medicines such as dosage alterations, medicines ceased or new medicines prescribed, the current medication list in the patient's record should be reviewed and updated. This reduces the risk of inaccurate medication information being transferred to other care providers in referrals. Providing patients or carers with an updated list when medicines are changed and encouraging them to maintain their own medicines list is an important component of the medication reconciliation process.

Involving patients in medication reconciliation
Engaging the patient is one of the best strategies to prevent reconciliation errors and a patient-centred approach to medication reconciliation is recommended. When patients present a list of their medicines, or the medicines themselves, on admission to hospital the risk of medication errors and harm is reduced. Any discrepancies should be discussed with the patient, and enquiries made about medicines prescribed by other prescribers and any over-thecounter or complementary medicines they are taking.

Evidence for effectiveness of medication reconciliation
Medication reconciliation significantly reduces medication errors and adverse events. Errors prevented by medication reconciliation include inadvertent omission of therapy, prescribing a previously ceased medicine, the wrong drug, dose or frequency, failure to recommence withheld medicines and duplication of therapy after discharge. Implementing formalised medication reconciliation at admission, transfer and discharge reduces medication errors by 50–94% and reduces those with the potential to cause harm by over 50%. The process is also associated with improved patient outcomes and a tendency for reduced readmissions.

Efficiency
A standardised process for medication reconciliation reduces the work associated with the management of medication orders. Time savings for nurses of 20 minutes per patient at admission and pharmacists of 40 minutes per patient at discharge have been reported.

Conclusion
The process of medication reconciliation, using a formalised structured approach involving patients and carers and conducted in an environment of shared accountability, can reduce the morbidity and mortality of medication errors that occur at interfaces of care. Medication reconciliation is a cost-effective use of the health dollar and an important element of patient safety.