There are many different areas that nurses must focus on in order to provide the best care for a patient. From the first moment the nurse and the patient get to communicate at the admission interview to the point of discharge, the patient’s well being is in the hands of the healthcare team. The nurse plays a pivotal role in carrying out the orders of the doctors and constant communication must occur between all providers to ensure good quality of care. The main focus of this paper is to emphasize the importance of medication reconciliation in the healthcare setting following the client from beginning to end in the hospitalization process.
Definition of Medication Reconciliation
Medication reconciliation is “ the verification and communication of a patient’s medication regimen at points of transition in patient care” (Murphy, Oxencis, Klauck, Meyer, & Zimmerman, 2009, p. 2126). The first step in ensuring medication reconciliation is during the health history upon admission to the hospital. Unfortunately accuracy is not always guaranteed during the initial assessment. Many registered nurses (RN’s) and advanced practice nurses (APN), felt “ challenged and frustrated by their inability to obtain complete and accurate medication information” (Riley-Lawless, 2008, p. 94). The inaccuracy in fully comprehending the patient’s medication history can lead to unsuitable drug therapy during hospitalization and result in “ failure to detect drug-related problems that may have contributed to a patient’s hospitalization” (Murphy et al., 2009, p. 2126) in the first place. In order for the health care team to provide the best care for a client, a comprehensive evaluation of all medications must be done. Sadly, it is not always the client’s fault, but their lack of understanding and knowledge on the medication previously prescribed which impedes the nurse from acquiring accurate information and providing proper care.
Paradigms
Person
Person refers to the human being as a whole, in mind, body and spirit, whether it be “ each individual man, woman or child”(Chitty & Black, 2007, p. 294). Each patient who comes to the hospital must be seen as an individual. Each patient has different beliefs, ideas and expectations in their own life. Most clients understand and know their limitations, have their own definition of health, and prioritize their basic human needs in different order from one another. In the care of the patient, it is the nurse’s role to assist them in meeting their basic needs. Medication reconciliation plays an important part in re-establishing homeostasis in the patient’s health. The physician prescribes medication that is essential in the recuperation of the client or many times prophylaxis to their health.
Throughout the care given in the hospital, many health care providers are responsible and held accountable for medication errors. Therefore it is important for everyone involved to check the medication administration record for discrepancies in order to provide safe and accurate care. In a hospital setting, the patient will be discharged where the “ physician reviews the medications and finalizes the discharge medications. The nurse then has responsibility for finalizing the instructions, including medications, and reviewing them with the patient”(Levick, Haldeman, & Beck, 2009, p. 19). It is the healthcare team’s responsibility to be knowledgeable of the patient’s diagnosis and to ensure that the medication being administered will promote health and well-being for the patient in the end. The nurse must give information and teaching to the patient prior to discharge from the hospital, consequently providing continuation of care outside of the hospital. The person, as the patient, is the main focus in medication reconciliation, where an individualized plan of care must be given in order to fulfill the patients need and assist in a prompt recovery.
Environment
Medication reconciliation extends to all units in the health care field, including transportation of patients from one setting to another. According to Chitty and Black (2007), the environment “ includes all the circumstances, influences, and conditions that surround and affect individuals, families and groups”. Unfortunately, many patients who enter the hospital setting do not always leave to return to their home, but must be placed in long term care. During the transfer from one location to another “ adverse drug events attributed to medication changes (due to differences in institutional and outpatient formularies) occurred in 20% of patients transferred from a hospital to a long-term care facility”(Setter et al., 2009, p. 2028). The adverse drug event could have been prevented if the communication between the two institutions would have been greater.
The patient’s well being is jeopardized if medication reconciliation is not followed thoroughly. In certain facilities steps have been taken to improve the communication between each department in a hospital where a computer system was created to assist the health care team in medication reconciliation. This computer system allows clinicians to easily compare current inpatient medications, with home medications that were documented at admission and medications being planned for discharge. According to Levick et. al (2009), ” with this system, the discharge nurse is alerted to any medication changes, even if they take place at the last minute” (p. 19). This provides the discharge nurse with accurate information and precise patient teaching even is changes are made suddenly and unexpectedly. The advances being made in technology affect the environment and the care that is given to the patient. The client is able to benefit from medication reconciliation in an environment that fosters communication between the staff in the healthcare team.
Health
Health is defined differently from person to person. One definition of health is a “ state of optimal functioning or well-being” (Taylor, Lillis, LeMone, & Lynn, 2008, p. G-10). It is the patient’s own level of health to where it is most favorable to them. Someone who has a chronic illness and is solely confined to a bed, might see themselves as healthy for simply being able to dress by themselves one morning, while an athlete might see a an injury to their foot as an impairment to his or her own health. A person’s view of health also changes daily on how their body is responding to the environment and treatments being done at the present time. This is one of many factors that prompts the nurse to provide individualized care to each patient under her care.
The patient’s health is greatly affected by medication reconciliation. The nurse must ensure that the correct medication and dosage is being given to the patient to reach a therapeutic affect and not to cause an adverse reaction. If the client gets an overdose of a medication, the health care team will be held accountable for probable damages that the medication caused. Initially, the medication is ordered to be administered and to cure the disease or control the symptoms. If an error is made along the chain of medication reconciliation, then the physical damage done to the body could be irreversible and even fatal if not caught in enough time. Medication reconciliation is put in place to prevent such accidents from occurring in the health care setting. It has “ been identified as a mechanism to promote patient safety and prevent harm by reducing medication errors” (Riley-Lawless, 2008, p. 94). It is extremely important for the nurse and everyone involved in the care of the patient to promote the health and well-being of the client. It is a crucial step in the treatment for the healthcare team to ensure that medication reconciliation is being followed through in order to provide the best care possible to the client who comes in the hospital seeking help.
Nurse
Medication reconciliation is of the nurse’s primary role in giving the patient good quality of care. In order for the nurse to expect a full recovery or to manage the patient’s health issues, careful attention must be paid to the medications being administered. The nurse must check the doctor’s orders with a drug guide book to ensure that the drug or drugs that will be administered will not cause an adverse reaction or cause further health deterioration to the patient. Medication reconciliation is a process that begins at the admission interview. The nurse must acquire all the medication information in which the patient is currently taking, follow it through with the care of the patient, and finally teach the patient about the medications that will be sent home with them. Since not all patients get discharged home and some get relocated, communication between the two places must be established in order to prevent side effects and drug interaction. The nurse plays a major role in medication reconciliation in order to provide the patient with top quality care and must ensure that no damage will be caused by a medication error.
Nursing Implications
Medication reconciliation exists to ensure that the patient who comes in seeking medical care is given the best possible care free of errors by the healthcare team. It is the nurse’s job to apply the knowledge gained in school and experience at work to ensure the physician is ordering the proper amount of medication for the patient and that the drug is going to be beneficial in the treatment of the medical diagnosis. It is very important for the nurse to be certain that everything about the drug will be fully explained to the patient in simple terms so that they are able to fully comprehend the right dosage, the reason for the medication and how to properly self-administer the medication.
Medication reconciliation also occurs within the hospital, from unit to unit. It keeps the flow of communication open with the other healthcare team members to give appropriate care to the client. Medication administration follows the patient from the moment of admission to the point where the patient is eventually discharged or transferred to another facility. It is imperative that no medication given to the patient will harm the client and cause further deterioration to their health.
Conclusion
In conclusion, medication reconciliation is essential to providing optimum care for the patient in any healthcare setting. Medication reconciliation follows the four paradigms in nursing and is essential in providing good quality care to anyone who seeks medical assistance. It opens up the field of communication between all units in the hospital that are involved in the client’s care and maximizes the interaction of two facilities in case a patient gets relocated. Medication reconciliation also decreases the chances of giving the patient a wrong medication or dosage. All healthcare members involved in the client’s care must be aware of the medications involved and must be check for errors in order to ensure a therapeutic result in the patient’s health.
