Drug Topics - November 5, 2007 - (Page 44)

44 DRUG TOPICS NOVEMBER 5, 2007 www.drugtopics.com VIEWPOINT Bruce Canaday, Pharm.D. Whose job is medication reconciliation, anyway? ho should take ownership of medication reconciliation? The Joint Commission tells us that medication reconciliation is a process made up of five steps: develop a list of current medications, develop a list of medications to be prescribed, compare the medications on the two lists, make clinical decisions based on the comparison, and communicate the new list to appropriate caregivers and the patient. An argument could be made that the first two steps are no more than making lists, the third step is simply looking for differences in those lists, and step five is communicating them. Step four appears to be the only one requiring a trained healthcare professional to carry out the function involved. I would disagree with this assessment. I believe there is a significant level of clinical expertise necessary to perform all five functions. Step one involves asking patients what medicaOutpatient tions they are Inpatient on, transferCare Care ring medication lists between community and institutional pharmacies, and contacting prescribers to develop a list of drugs patients are taking. Step two, or choosing the “right” medications to prescribe for a patient, should be part of a very well thought out, patient-specific therapeutic plan requiring, at a minimum, knowledge of the patient’s conditions, the desired outcomes, and a clear understanding of the risks, benefits, and proper use of each medication under consideration. Similarly, step three should be a comparative clinical evaluation of the medications on the two lists based on the above criteria, leading directly to step four. Step four, the “clinical decisions” piece, requires the highest level of expertise to ensure that the “right” medications are used to optimize patient outcomes. The final step, communicating the new list to appropriate caregivers and the patient, while no less critical, should be handled by the best communicator available. So who is best qualified to fulfill these five steps? W is a clinical professor in the division of pharmacy practice and experiential education at the University of North Carolina. He is a former president of both APhA and ASHP. THE AUTHOR Illustration: Dynamic Graphics, Inc. Successful execution of these five steps mandates a knowledge base that is, I believe, unique to the pharmacist. Certainly other professions can and do bring something to the table. I’m not saying that pharmacists are the only option. However, the person “responsible” for execution and the outcome should be a pharmacist since pharmacists are the best trained in medication management. To quote the old Carly Simon song, “Nobody does it better!” But accepting that “medrec” is our responsibility is only half the battle. What does responsibility mean? If we are to accept responsibility, we cannot do so by remote control. I have seen too many pharmacists claim responsibility for medrec when all they’ve done is sit on a committee that designed a process of developing a medication listing on the front end. Meanwhile they’ve deferred the work of medrec to nurses, aides, and others. Why are so many pharmacists content to sit on the sidelines and watch? Why are we not stepping up to use our professional expertise to deal with the issue of poor communication of medical information at transition points that is responsible for so many medication errors and adverse drug events? Ultimately, the most common argument against having pharmacists do this is lack of resources—code for “money.” While we have to be fiscally prudent, our ultimate responsibility must be to provide the best possible patient care. At the end of the day, resource allocation is not about how much money there is—there is a lot of money in health care—it is about how the money is allocated; it is about priorities. Shame on hospital administrators for not recognizing that having pharmacists actively engaged in this process should be a priority. And shame on us for not being able to convince our bosses, our colleagues, and our patients that our skills are worth paying for because we can reduce medication errors and adverse effects due to medications. Personally, I think the “best care possible” standard is met by asking, “Would that be what I want for my mother?” In this case, the person I want making decisions about medication use for my loved ones—taking responsibility for medication reconciliation—will have “pharmacist” on his or her name tag. http://www.drugtopics.com

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Drug Topics - November 5, 2007 Contents Latebreakers Latebreakers in Depth Letters Rx Care Community Practice 150 Years of American Pharmacy Hospital Practice Pharmacists at Risk Government and Law High-Density Lipoprotein New Products Advertisers Index Classified Viewpoint

Drug Topics - November 5, 2007

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