News Courtesy of: Jake Berenguer, Mass Communications Specialist 3rd Class
SAN DIEGO (January 22, 2009) - Understanding medications and tracking multiple prescriptions can be a challenge for both patients and medical providers. Naval Medical Center San Diego (NMCSD) implemented a program to help patients understand their medications and assist providers by providing a clear picture of patients’ medication status.
Medication Reconciliation is an accurate list of prescriptions provided to the patient at the end of every appointment, according to Cmdr. John S. Hammes, chairman, department of Internal Medicine, NMCSD.
"For each and every patient we see in the clinic, we are sure to ask them if they have had a chance to review the medication list provided to them by the front desk when they checked in," said NMCSD’s head of Internal Medicine, Cmdr. Alan Douglass. "I have noticed that most patients will not produce the list until I ask about it."
At NMCSD all members of the healthcare team and patients are involved in the Medication Reconciliation process. Clerks and hospital corpsmen checking in patients generate a current list of medicines, present the list to the patient to review and note prescription conflictions that may be present. Some medications can cause serious reactions if mixed with certain other prescriptions. To avoid that, their provider reviews the list and makes corrections as needed.
If there is confusion they contact the provider who prescribed the medication in question or their primary care provider. The patient is given an updated list at the conclusion of the appointment. For inpatients, a specific medication reconciliation worksheet is generated using the Electronic Medical Record, which tracks medications and provides an accurate discharge summary.
"It is important because inadequate or incomplete reconciliation results in patients taking too much, too little, the wrong type, or harmfully interacting drugs," said Hammes.
According to Hammes, lack of information about a patient’s medication history can cause serious adverse effects. Implementation in a national patient safety goal and a requirement for every accredited hospital in the U.S. NMCSD is committed to ensuring that all patients receive safe, quality patient care, according to Hammes.
"It is a national goal to improve the use of prescription drugs. We require every patient who visits a clinic or ward to update the medications listed in their record. Their medication list will then be either added or removed from their medical record," said Lt. Laura Baraniak, NMCSD’s senior nurse officer in the Medical Health Center. "Every patient should carry a list of all prescriptions and over the counter medications, herbals, and vitamins."
NMCSD has incorporated the medical reconciliation computer program in all clinics and support staff's computers according to Hammes.
"Since we began using the program we have cut down the time it takes to check in and check out a patient and it makes explaining the medications and precautions easier for them to understand," said dental assistant Hospital Corpsman 3rd Class Michelle Sabino. "Before we had the program, patients often got lost in the medical lingo and acronyms, and that’s exactly why this program was put into action. We want to know what they are taking, and we want to explain in detail what their medication does, track past prescriptions and determine if they are compatible."
The process was screened and adjusted over a period of three months through random patient selection. Results showed patients leaving the Internal Medicine Clinic with a clear and accurate understanding of their medication rose from 35 percent to 90 percent. All medication lists met the medical reconciliation standards set by the Joint Commission, and reduced waiting time by approximately five minutes per patient.
"We are having great results here at NMCSD in Internal Medicine, and I really appreciate how dedicated my staff is to ensuring that they are diligent about this," said Douglass.
"We have an obligation to make sure that each patient is safe and well cared for," said Sabino.