BETHESDA, MD 14 February 2011—Current medication reconciliation requirements from the Joint Commission are on schedule for major downsizing when a revised version of this National Patient Safety Goal (NPSG) goes into effect in July.
The revised medication reconciliation goal has 5 elements of performance, compared with 17 in the current set, which is active but does not count toward an organization`s accreditation status.
Maureen Carr, project director in the Joint Commission`s department of standards and survey methods, said the medication reconciliation goal was changed in response to comments from the field.
"The biggest problem was that it was way too prescriptive and detailed in terms of requirements and that it was difficult for organizations to implement," Carr said. She said the Joint Commission received 1700 public comments after releasing the revised standards, which underwent extensive field review and have been favorably received by stakeholders.
Bona E. Benjamin, ASHP`s director of Medication-Use Quality Improvement, said the revised goal is "much improved" from the original and should be easier to implement.
Notable changes for July include those to NPSG.08.02.01, which deals with reconciling medications during transitions in care.
In that goal, Carr said, "there was a requirement that the list of medications needed to be provided to the next provider of care. And that was problematic in many situations where there was no such person identified."
Performance element 4 of the revised goal, NPSG.03.06.01, instead states that the patient or family must be given written information on medications that should be taken after discharge or at the end of an outpatient encounter. The goal refers to provision of care, treatment, and services standard 04.02.01 for the Joint Commission`s expectations about communicating with other health care providers.
"We already talk about coordinating care in the standards, so we felt it really wasn`t necessary to be in a lot of detail in the national patient safety goal," Carr explained. "What we really did was streamline the goal and focus on what we felt were some of the risk points in the medication reconciliation process, but not the entire process of care."
The first performance element of NPSG.03.06.01 requires that a hospital obtain information about a patient`s preadmission medication regimen and document that information on a list or other format that is "useful to those who manage medications." This element acknowledges that obtaining comprehensive medication information may be difficult and states that a good-faith effort to do so is sufficient.
Performance element 2 requires the hospital to define the type of medication information to collect in "non-24-hour settings and different patient circumstances." These may include the emergency department and outpatient radiology, primary care, surgery, and diagnostic settings, according to the element.
Information that hospitals may choose to collect includes the medication name, dose, route of administration, frequency, and purpose. Carr said the Joint Commission`s medication management standards may also provide guidance about the type of information that is appropriate for hospitals to collect during medication reconciliation.
Performance element 3 requires hospitals to identify and resolve discrepancies between each patient`s preadmission medication regimen and drugs ordered during the hospital visit. Discrepancies, according to the element, include "omissions, duplications, contraindications, unclear information, and changes."
This comparison must be done by someone who meets hospital-defined qualifications, and Carr said that person could conceivably be a pharmacist, nurse, physician, resident, or student.
"We`re not prescribing who does it. It`s up to the organization . . . to demonstrate that they are qualified," Carr said. She said that determination must meet criteria described in the Joint Commission`s human resources standards.
The final performance element concerns educating patients at discharge about managing their medication regimen.
"When a patient leaves the organization, we expect [staff] to educate the patient [about] how important it is to keep their medication information updated, so next time they need to have a health care encounter they might have more accurate information," Carr said.
ASHP`s board of directors in October endorsed a white paper on medication reconciliation that urges stakeholders to view reconciliation as an important element of patient safety, not just an accreditation-related goal.
The report is the outcome of a 2009 stakeholders` conference during which participants agreed on the need for consensus on what constitutes a medication and what is meant by reconciliation. The group also agreed that the roles of participants in the reconciliation process must be clearly defined and that measures of success should be based on actions that clearly benefit the patient
According to the report, comprehensive medication reconciliation needs to be implemented in hospitals, but the group favored a phased implementation process to better ensure success.
The white paper was published in the Journal of Hospital Medicine and The Joint Commission Journal on Quality and Patient Safety and is also available at ASHP`s website.