Chapter 26 – Medication Reconciliation For Nurses

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Nurses can easily perform medication reconciliation, but there are several barriers that may prevent this vital task from being performed. These obstacles include: Time and effort; Patient-associated factors; and Low effort interventions. To overcome these obstacles, nurse must know the most important strategies. Listed below are some suggestions for medication reconciliation. Use them wisely!

Obstacles to medication reconciliation

The current literature describes a variety of barriers that prevent effective medication reconciliation. One common barrier is a lack of access to accurate pre-admission medication lists. This problem, sometimes referred to as the “garbage in, garbage out” phenomenon, may also be a barrier to physician engagement in medication reconciliation. Access to external patient histories may make it easier for clinicians to create accurate medication lists. But this research only addresses one of the barriers.

While the process of medication reconciliation has become standard of care for pharmacists, it is not always a simple task. In this study, we sought to better understand the factors that impede or facilitate medication reconciliation, as well as what factors are helpful in overcoming these barriers. In the process, we incorporated a theory of planned behavior to explore the obstacles nurses face and the factors that enable them to overcome them. We found that the theoretical framework underlying the process of medication reconciliation was most useful for nurses who perform the task.

Regardless of the setting, a standardized process for medication reconciliation is crucial for patient safety. However, without a clear definition of responsibilities, a lack of standardized protocols and policies can impede effective communication among healthcare professionals. Medication reconciliation should be a collaborative effort involving all team members. And once it is mastered, it can lead to active medication management. That’s why it’s important to consider integrating medication reconciliation into patient care.

Increasing specialisation can also lead to obstacles in effective medication reconciliation. Specialist doctors may only consider the use of certain medicines that require a specific level of expertise. The integration of non-medical professionals can limit the effectiveness of multidisciplinary teams. As a result, a nurse may not be able to question the decision-making process of physicians when making prescription changes. For example, a pharmacist may not be familiar with the drug a patient is taking.

Lack of awareness about medication reconciliation is a common barrier. Healthcare professionals may be hesitant to reallocate medication reconciliation tasks, as it is a complex process. Further, some healthcare professionals lack the necessary knowledge about medicine reconciliation and may be unable to implement it in their practice. In this way, the process may not be successful if the workforce is unaware of the benefits of medication reconciliation. The underlying problems may not be so obvious.

Time consuming process

In a recent study, nurses and pharmacists rated how long it took them to perform medication reconciliation. While nurses rated the process as time-consuming, physicians rated it as time-efficient. Both groups considered themselves the main providers of care. According to the study, nurses were twice as likely as pharmacists to choose this process, but pharmacists did not. The reason behind this was that pharmacists and physicians viewed it as a secondary care provider.

The time-consuming process of medication reconciliation is made even more difficult by the fact that nurses and physicians are responsible for managing a complex patient’s medication history. The average patient has more than a dozen prescriptions on their profile. Reconciling this information manually can lead to errors. Nurses should also consider the safety implications of a faulty reconciliation. In addition to ensuring that the correct dosage is administered, the process should ensure that the patient’s health is not put at risk by the administration of an incorrect medication.

Nursing staff are crucial to the proper administration of medicines. During the time spent performing medicine reconciliation, nurses must assess the current medications of patients, identify discrepancies, and ensure that the medication order is correct. Some nurses review transfer documents and consult with patients and their families, while others simply assume that the medication orders provided at the transfer were correct. Despite the difficulties nurses face, this cognitive process can be done by them.

Medication reconciliation can improve efficiency by streamlining the process. In the past, nurses and physicians conducted individual medication histories. However, a more coordinated approach can reduce the number of errors. Besides, medication reconciliation can be standardized by using electronic health records (EHRs).

Patient-associated factors

Medication reconciliation processes are highly error-prone, complex, and lack standardization. Many contributing factors include limited resources, limitations of electronic health records, and multiple care transitions. To address these challenges, a team of researchers designed and validated a new, systematic process for medication history documentation, MARQUIS2, and additional lists of medications. These processes were used by clinical nurses at five different health care facilities.

A study shows that by using an electronic system, the number of unintended discrepancies decreased by 43 percent. This reduction in unintended discrepancies may help reduce the risk of medication errors, although it is still necessary to implement a standardized medication reconciliation process in health care settings. Further, the study included an auditing tool to track results over time.

In addition to this study, another group of studies examined the medication reconciliation processes at SNFs. In these studies, nurses were asked to complete questionnaires containing 13 items related to patient satisfaction and the validation of the VA medication reconciliation tool. The results revealed that these questionnaires largely mirror the same survey questions but included different patient-related items. Moreover, nurses were more likely to report discrepancies if they were unable to obtain information from patients’ family doctors.

Another study focused on nursing role in medication reconciliation, wherein a cross-sectional survey of 14 nurses in Brazil found that many of them had no knowledge of their medication reconciliation roles. However, some nurses were unsure of their roles in medication reconciliation, despite having clinical experience. This study confirms previous findings. In addition to nurses’ role in medication reconciliation, a lack of clinical practice guidance has led to a perceived need for further research.

Low-effort interventions

Nurses’ efforts to perform medication reconciliation are frequently compromised by errors and failures. The most common mistakes include incorrect medication orders, omitted or incorrect doses, and errors in order entry and transcription. Most events are discovered only after a change in a patient’s condition requires medication adjustment. Those patients who require medication change were often hospitalized, or they were in need of emergency care or intensive care.

The aim of medication reconciliation is to reduce adverse drug events. Although evidence of this goal is limited, early signs are encouraging. At UMass Memorial, reconciliation is associated with fewer ADEs. Nurses who engage in medication reconciliation report fewer ADEs. Low-effort interventions have the potential to reduce medication errors and improve patient outcomes. However, further research is needed to determine the optimal combination of interventions. This is an exciting area for future research!

One of the challenges of reconciliation is obtaining complete information about the medication history of the patient. Physicians, nurses, and pharmacists document this information in different locations and rarely compare them. Several studies have examined the effectiveness of low-effort interventions for medication reconciliation, but the most significant research concerns how the tools are implemented. Some have even suggested that nurses should use interdisciplinary teams, such as physical therapists, occupational therapists, and pharmacists, to facilitate medication reconciliation. The implementation of such a team is crucial because this ensures that all involved parties are working together.

Despite the success of medication reconciliation programs in research, the process of implementation is often difficult in the real world. Implementing medication reconciliation interventions in general practice has proven to be a challenge because the interventions require high resources, create confusion, and conflict with other priorities in the healthcare system. As such, many health care organizations have prioritized medication reconciliation for their quality improvement efforts. If implemented correctly, medication reconciliation can improve patient safety and improve patient outcomes.

Low-effort interventions for medication reconciliation for nurses can have a significant impact on patient safety. By improving medication safety, this project can improve patient safety and increase nurse efficiency by reducing the burden on staff. This project can also be integrated into an overall hospital strategic quality plan. By aligning the project with a hospital’s quality improvement plan, low-effort interventions can be implemented more effectively and sustainably. This will ensure that the system continues to be a source of high-quality care.

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