Drug Topics - November 19, 2007 - (Page H14)

14HSE DRUG TOPICS NOVEMBER 19, 2007 www.drugtopics.com Special Report Do pharmacists at your hospital counsel patients on their drug regimens prior to their discharge? Do you think pharmacist discharge counseling would improve medication reconciliation? Not sure 16.2% NO 10.7% YES 73.1% YES 24.8% NO 71.4% Not sure 3.6% of existing policies. While nearly 86% of respondents said their hospitals have a reconciliation policy in place, the details of those policies were as varied as the participants. “A form is filled out upon admission by the nurses, and at discharge it lists the drugs [strength and directions] the patient currently takes,” wrote one respondent. “This list is faxed to the hospital pharmacy on admission to check for discrepancies between home meds and admission meds. If there are any discrepancies, the physician is notified.” Another respondent described the reconciliation policy at his hospital as “home medications entered into a computer system which generates a reconciliation sheet giving the physician the option to discontinue, continue, or change any home meds the patient came into the hospital on. This has to be done within 24 hours.” Some policies, according to the survey, rely on taking accurate histories from patients. “Patients are asked what meds they are on at home, and a list is placed on the chart, with a copy going to the pharmacy,” commented one pharmacist. “When they are discharged, the pharmacy generates a med reconciliation form listing the current discharge meds. We ask about the meds they were taking at home, and place them on the list if pertinent. One copy is given to the patient and the other copy goes to medical records.” Whose job is it? One of several issues complicating the medication reconciliation process at hospitals is that of responsibility. The survey results show that pharmacists, nurses, and physicians share the responsibility of reconciling medications almost equally: 67% of respondents said pharmacists handle reconciliations, 73% said nurses handle them, while 52% claimed physicians are in charge of the process (participants were told to select all that apply). “At this point, all patients in all departments must have a reconciliation done within 24 hours by a pharmacist,” wrote a survey participant. Others pinned the responsibility on nursing staff, physicians, or medical residents. “At this point, it is the responsibility of the medical residents and the nurses to ensure that med rec is done,” said another respondent. “The pharmacists are not directly involved.” But they should be, according to our respondents. More than half of those polled—54%—believe a department in their hospital should be designated to oversee the reconciliation process, and 77% said that department should be pharmacy. Only 11% thought it should be nursing, and just 7% said it should be physicians. “It’s clear that pharmacists can play a pivotal role in managing medications within their institutions,” Chen noted. “Pharmacists are trained and skilled at taking medication histories and managing that information to execute an effective medication reconciliation process. Pharmacists should provide the leadership for that process.” Not necessarily, ISMP’s Vaida said. Giving hospital pharmacists the responsibility of reconciling patients’ medications is not always the smartest move, he argued. “It’s not an easy answer to say ‘Well, let’s just let nurses take care of it,’ or ‘Let’s just let pharmacists take care of it,’” Vaida stressed. “As part of the process you put in place, you should look at how the patient is coming into your system and then look for the individual who can do it the best and do it in the shortest amount of time.” And that’s not an easy task, considering that worker shortages continue to plague the nursing and pharmacy professions. At many hospitals, staff members simply do not have the time to comply with medication reconciliation policies—a troubling fact reflected in the survey results. Of the 640 pharmacists who responded to the survey, 35—or 6%—said their hospital’s staff reconciles patients’ medications “not closely” or “not at all.” Asked for a reason for the noncompliance, 50% cited lack of time, while 59% said supervisors do not enforce the policy. Both answers, however, are poor excuses for not ensuring that there is seamless care when it comes to patients’ medications, Vaida argued. “When you deal with [healthcare] institutions, everyone is busy,” he noted. “You’re going to have to find the time and step up to the plate. As a pharmacist, you can’t say that medication reconciliation is very important and we should have some involvement, but I don’t have the time and I only counsel one-quarter of the patients anyway. Taking responsibility for [reconciliation] doesn’t always mean you have to be the person doing it every time. You just need to make sure it’s getting done and all the steps are being followed.” DT Please check the Drug Topics Web site for more results from our exclusive survey. http://www.drugtopics.com

Table of Contents Feed for the Digital Edition of Drug Topics - November 19, 2007

Drug Topics - November 19, 2007 Contents Latebreakers Letters Leukemia Patients Now Have More Options First-in-Class HIV Drug Boon to Patients at End of Tether 150 Years of American Pharmacy Pharmacy Schools Confront New Pressures From Pariah to Patient ACCP Releases Position Paper on Ethical Interactions New Injectable Antibiotic Welcomed with Open Arms NCCN Updates Head and Neck Cancer Guide Improved Phosphate Binder Approved for Dialysis Patients Considering Combination Concern Ensuring Seamless Care Bill Would Create Center for Comparative Effectiveness Hospital Improves Patient Safety with Automatic Drug Distribution System Infection Rates, Patient Stays Drop with New Drug Device How R.Ph.s Helped Three Hospitals Win Quality and Safety Awards A Pharmacist and Dog in Tow are Alzheimer’s Patients’ Best Friends More PBMs Agreeing to Pricing Transparency New Insulins in the Management of Diabetes New Products Advertisers Index Classified VIEWPOINT: Reflections on Pharmacy School After 30 Years

Drug Topics - November 19, 2007

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