If you were asked which medicines you take, could you answer? Is it a little white pill from your family doctor or is it a pink tablet from your heart specialist? Do you know the name? Do you know what it is for? When are you supposed to take it? Twice a day, at night, with meals? What is the dose? If you found it difficult to answer these questions, chances are you wouldn’t be able to answer them at a health care facility, where accurate answers are very important in providing safe care.
This uncertainty can cause patients to get medicine that they aren't supposed to get and not receive medications they need. Hospitals and health care providers are now partnering with patients to prevent adverse drug events (ADEs) that result from wrong or incomplete information about the medications patients are taking.
As many as half of all medication errors and one-fifth of ADEs are preventable. What is an ADE? The Joint Commission on the Accreditation of Healthcare Organizations describes an ADE as: “Any incident in which the use of a medication (drug or biologic) at any dose, a medical device, or a special nutritional product (for example, dietary supplement, infant formula, medical food) may have resulted in an adverse outcome in a patient.”
Definitions of ADEs vary organization to organization, but most are broad enough to include “near misses” and “close calls.” They also include expected and unexpected side effects. Medication errors and ADEs in health care often occur as a result of communication errors at important points in patient care. Miscommunication most commonly occurs upon admission, transfer and discharge.
The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) is an independent body that evaluates the safety and quality of care of more than 15,000 health care providers. Receiving accreditation status from JCAHO (pronounced “jay-co” in health lingo) is important to providers who want to provide quality care and remain competitive in the health market.
What does JCAHO have to do with medication errors and ADEs? JCAHO establishes annual National Patient Safety Goals for providers to comply with and follow. A 2006 patient safety goal requires hospitals to create a formalized process of medication reconciliation.
Medication reconciliation refers to the process of comparing patients’ current medications to newly ordered medications during treatment at a health care organization. The process is aimed at reducing preventable medication errors.
While most hospitals have always had processes for comparing home versus newly prescribed medications, there is always room for improvement. Hence JCAHO’s focus on the creation of formalized, clear, monitored reconciliation processes as a safety requirement for accredited hospitals.
Medication reconciliation involves three components: verification (collection of medication history), clarification (ensuring that medications/dosages are appropriate) and reconciliation (documentation of changes in medication orders). This process would occur upon admission, transfer within a health care facility, or discharge to another level of care outside the facility. Many accredited hospitals are already creating teams and formalizing procedures for medication reconciliation.
What can you do? Help health care providers by becoming an active participant in your own health care. Here are some tips:
- Create a list of all current medications, including those that are prescribed
- Don’t forget to include herbal supplements and vitamins.
- Include important elements such as dosage, route, frequency, strength.
- Ask your physician for help in creating a more accurate list.
Ashlee Kibe is a Health Policy and Administration student at Penn State University, and she is serving an internship with Gail A. Miller, RN, MS, in the Performance Improvement and Education Department at Mount Nittany Medical Center.