The Joint Commission has announced its field review for its new medication reconciliation goal (NPSG.03.07.01) and is accepting comments up to May 11, 2010. The new goal is less proscriptive and appears to give hospitals considerable flexibility in their approaches. It does, however, link the medication reconciliation process to multiple other elements that are contained in several other standards related to medications and provides a graphic showing the links to many of those other standards (eg. that a pharmacists reviews all medication orders, etc.).
It requires hospitals collect information about a patient’s medications on admission or when the patient is seen in the outpatient setting. However, it allows the hospital to define the types of medication information to be collected in different settings. For example, while for admitted patients you would presumably collect information about medication name, dose, frequency, route, and time of last dose taken, for patients seen in the ER but not admitted you might require time of last dose taken only for high alert medications. It also allows the hospital to define the qualified medical professional who does the comparison.
The hospital still needs to compare that medication information with any medications ordered during the hospital admission/encounter and reconcile any discrepancies. This should also be done any time there are new or revised medication orders. And at discharge written information on the medications should be provided to the patient (and family, if appropriate).
The revised goal also stresses the importance of educating the patient about the importance of keeping updated information about their medications readily available.
Lastly, it requires that your performance improvement process evaluates the effectiveness of your medication reconciliation program.
We think that this revised goal is reasonable at this time. Until best practices become clearly defined for medication reconciliation we believer that hospitals need some latitude in their processes for ensuring safe and effective medication reconciliation. Hopefully as hospitals progress in their efforts to meet “meaningful use” of healthcare information technology, their will be enough interoperability to allow for adequate exchange of information about a patient’s medications across multiple healthcare venues.
See also our previous columns on medication reconciliation:
The Joint Commission.
National Patient Safety Goal: NPSG.03.07.01 (Medication Reconciliation)
March 30, 2010.