The Joint Commission’s #3 National Patient Safety Goal (NPSG) in its 2018 Hospital Accreditation Program is to improve the safety of using medications. TJC has put medication safety toward the top of its goals given the evidence that medication discrepancies and errors can affect outcomes, stating: the large number of people receiving care, treatment, or services who take multiple medications and the complexity of managing those medications make medication reconciliation an important safety issue.
In short, medication reconciliation is a clinician’s comparison of the prescribed medications a patient is actually using against the new medications ordered for the patient during an encounter, resolving any discrepancies, and updating the medical record to reflect them.
Here’s what you need to know and do about medication reconciliation guidance in the Joint Commission’s NPSG.
1. Ensure your team is capturing the complete list of what patients have been prescribed, as well as what they are actually taking.
A complete and accurate list is essential to a clinician’s ability to accurately diagnose and treat. That said, it’s widely recognized, including by the Joint Commission, that getting medication reconciliation done well and right is difficult.
Our research and interviews with more than 20 hospital chief medical officers and quality executives corroborates this. Based on their feedback, some of the reasons include: medication information being in multiple systems, lack of enough or the appropriate type of staff on certain shifts, and of course, the well-known inconsistencies and inaccuracies of patient self-reporting. Further, the time involved to review current medications, ask about additional ones, and identify the brand, dosage, and frequency are also big issues in busy emergency departments (ED) and clinics.
2. Recognize that a good faith effort meets the intent of the Joint Commission requirement for medication reconciliation.
It’s the job of healthcare leaders and clinicians to put effective protocols in place and verify that teams are following them. But while being 100% accurate with medication reconciliation is certainly the goal, given the aforementioned challenges, realistically, it won’t be reached every time. Until we have integrated technology systems that can deliver complete and accurate data, there may still be gaps. In addition, hospitals must juggle patients who are incoherent, unconscious, and unable or unwilling to provide their medication information.
As a result, the Joint Commission notes in its elements of performance for this goal, a good faith effort to collect this information is recognized as meeting the intent of the requirement.
3. Compare and reconcile all the medications identified.
This means developing an accurate list of which are actually being taken (removing those that aren’t) and which will be changing or added as a result of the current encounter. Note all discrepancies, which the Joint Commission defines as omissions, duplications, contraindications, unclear information, and changes.
4. Update the patient’s record with the reconciled, accurate list.
This is a final step of any successful medication reconciliation protocol. In most EHRs, the information is documented in a list format, so that all medications can be reviewed in one place by the next provider who sees the patient.
5. Give patients and families written information about the medications you prescribe as a result of the encounter.
Explain the reason for prescribing them and how to take them. Using teach-back methods can ensure for the clinician that the patient has understood the instruction.
6. Impress upon patients the importance of managing their medication information.
This can mean instructing patient and family members to provide the updated list to the patient’s primary care provider. Or, to keep it in a safe place at home, and take it to each physician visit. Be sure patients understand that any new over the counter medications and supplements should be added to the list, and communicated to the primary care physician on their next visit.
 National Patient Safety Goals Effective January 2018, https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2018.pdf