In 2005, The Joint Commission added medication reconciliation as a National Patient Safety Goal (NPSG). It's part of the third NPSG, which focuses on medication management and using medications safely. More specifically, the medication reconciliation NPSG is identified as NPSG.03.06.01 and includes five elements of performance.
Medication reconciliation is included as an NPSG for the following Joint Commission programs: hospital, ambulatory healthcare, behavioral healthcare and human services, critical access hospital, home care, nursing care, and office-based surgery. The Joint Commission explains the rationale for the med rec NPSG as follows:
"There is evidence that medication discrepancies can affect patient outcomes. Medication reconciliation is intended to identify and resolve discrepancies—it is a process of comparing the medications a patient is taking (or should be taking) with newly ordered medications. The comparison addresses duplications, omissions, and interactions, and the need to continue current medications. The types of information that clinicians use to reconcile medications include (among others) medication name, dose, frequency, route, and purpose. Organizations should identify the information that needs to be collected in order to reconcile current and newly ordered medications and to safely prescribe medications in the future."
The Joint Commission summarizes the NPSG by stating, "Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor."
In short, medication reconciliation is a clinician’s comparison of the prescribed medications a patient is using against the new medications ordered for the patient during an encounter, resolving any discrepancies, and updating the medical record to reflect them.
6 Steps to Comply With the Joint Commission Medication Reconciliation NPSG
Here are six steps you should take to better comply with about the medication reconciliation National Patient Safety Goal.
1. Document medication regimen
Ensure your team is capturing the complete list of what patients have been prescribed and what they are taking. A complete and accurate list is essential to a clinician’s ability to accurately diagnose and treat a patient and their conditions. That said, it’s widely recognized, including by The Joint Commission, that getting medication reconciliation done well and properly is difficult.
Research and interviews with more than 20 hospital chief medical officers and quality executives corroborates conducted by Cureatr verifies this sentiment. Based on their feedback, some of the reasons why medication reconciliation can provide so difficult include the following:
- medication information is stored in multiple systems;
- there is a lack of enough or the appropriate type of staff on certain shifts;
- patient self-reporting of medication information is often inconsistent and inaccurate; and
- the time involved to review current medications, ask about additional drugs, and identify the brand, dosage, and frequency of those medications are challenging, particularly in busy emergency departments (ED) and clinics.
2. Strive to perform complete, accurate medication reconciliation
It’s the job of healthcare leaders and clinicians to put effective protocols in place and verify that teams are following them consistently and properly. But while being 100% accurate with medication reconciliation must always be the goal, given the aforementioned challenges, it likely won’t be reached every time medication reconciliation is performed. While we now have technology systems that can help deliver complete and accurate medication data, there may still be gaps. The risk for such gaps increases when providers are caring for patients who are incoherent, unconscious, and unable or unwilling to provide their medication information.
As a result, the Joint Commission notes in the medication reconciliation elements of performance for this National Patient Safety Goal, "A good faith effort to collect this information is recognized as meeting the intent of the requirement."
3. Compare and reconcile all medications identified
This step requires developing an accurate list of which medications are actually being taken, removing those that aren’t, and documenting those medications that will be changing or added as a result of the current encounter. As part of the medication reconciliation process, you should always 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 medication list
This is an essential step for any successful medication reconciliation protocol. In most electronic health records (EHRs), medication reconciliation information is documented in a list format, so that all medications can be reviewed in one place by the next provider who meets with the patient.
5. Provide information about new or changed medications
Whenever you make a change to a patient's regimen following an encounter, take the time to explain the reason(s) for the change, cover any new information about frequency and route, and provide a summary of this information in writing to the patient and any accompanying family members. Using teach-back methods can help ensure a patient and/or family member understands the new instructions.
6. Emphasize the importance of managing medication information
This can mean instructing patients and family members to provide the updated medication list to the patient’s primary care provider or keeping it in a safe place at home to take 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 during their next visit.
Additional Medication Reconciliation Best Practices
Looking for more information that can help you strengthen your medication reconciliation procedures and performance? Consider checking out this blog, which outlines med rec steps you should take during every transition of care, and this blog, which further explains why medication reconciliation remains such a substantial challenge for organizations and providers despite the fact that medication reconciliation has long been recognized as a critical patient safety process.