Medication Reconciliation in LTC

To the Editor: I enjoyed reading “Medicine Reconciliation and Seamless Care in the Long-Term Care Setting.”¹ My main admitting hospital is very "quality” concerned. Therefore, they have initiated a mandatory medicine reconciliation form at discharge. Oftentimes, my patients from the nursing home are admitted when I am not on call. The patients come in through the Emergency Department and are admitted by the call physician for the group. They generally get better within 72 hours, and then it is time to discharge them. Usually I am the one who does the discharge, and the hospital makes sure that I fill out the medicine reconciliation form. This presents several problems:

1. It, of course, slows down my pace on morning rounds.

2. It creates yet another place where transcription can cause an error.

3. It generates a call back, generally, from the next shift of nurses who actually do the discharge.

4. It generates a call from the nursing home, who get confused because each time this form is recopied there are more errors made.

5. The biggest error occurs when the nursing home sends a patient in with the previous month’s "Medical Administration Record.” Drugs that have been recently placed or deleted are therefore not registered. Now, those mistakes are magnified with each round of "reconciliation.”

I have gone around and around with administration and have asked that they simply do the following: 1. Please continue previous nursing home medical administration record with the following additions and deletions.

2. If the nursing home has any questions, please call us specifically about them, and flag this for rounds so that I can reconcile them myself with the nursing home chart on rounds. (Rounds are done at the nursing home every other week.)

This way, the patient is restarted on medications he/she was taking, with known additions and deletions. We have found that this system causes fewer errors than any other. Until the president has us all on the same computer, reconciliation will be a problem. However, the fewer places to make transcription errors, the better!

Name Withheld

Reference

1. MacKinnon NJ, Kaiser RM, Griswold P, Bonner A. Medication reconciliation and seamless care in the long-term care setting. Annals of Long-Term Care: Clinical Care and Aging 2009;17(11):36-40.