Day in and day out, one of the duties of an inpatient care pharmacist
along with any type of pharmacist, is the duty to reconcile the
patient's home medications along with their profile review.
Back in 2008, the IHI (Institute for Healthcare Improvement) launched their 5 Million Lives
Campaign- to save 5 million lives through preventing medical harm in
from 2006-2008. They had twelve changes that they implemented throughout
hospitals- ranging from rapid response teams to preventing MRSA
infections. One of their major goals, however, was preventing adverse
events from occurring through medication reconciliation.
I admit, medication reconciliation is hard, no matter where you go.
Retail or hospital, medication reconciliation based on the patient's
response is pretty difficult. I'm not saying that patients don't know
what they're doing. But, believe me, I even have a hard time remembering
when my rental videos are due... do most patients even remember the
exact dosing of each medication among their twenty-seven other
medications that they take on a daily basis?
And
electronic health records are helping with this dilemma. I've had the
experience of using this first hand, with the clinic's Google Health system. Other systems, like that of DrFirst
are sprouting up as well. Yet, is patient compliance received with
these systems? By talking to individuals in the community, I've learned
that although the use of technology could be amazing, as the patient is
transferred from the community to inpatient (oh the errors we could
prevent!), the use of an individual's information (even if it is
protected) is a hard concept for those to allow to be broadcasted on the
internet.
It's even harder within the hospital. So much miscommunication and
confusion occur on a daily basis. Take for instance, I was in the
basement one day, verifying orders. A nurse calls down, stating that
another nurse had brought down a patient's medications during the night,
and that the patient insisted on taking his home medication (even if
the hospital could supply it). The nurse couldn't find it around the
patient, in the pyxis machine, so then I went on a thirty minute hunt
around the pharmacy- talking to everyone I could think of, going to the
narcotic pharmacy, the storeroom, the drug information center, pretty
much all over the pharmacy, in the search of these "home medications"
that the nurse couldn't find. Eventually she found them in the patient's
room- but all that work just for reconciliation.
But it's important. Yes, we may not be able to find that new Exalgo ER
or random benzo on formulary. But we've done our part for medication
reconciliation and instead find a suitable substitution. We bring the
patients one step closer to recovery, by resuming their home medications
to the best of their ability. The power of medication reconciliation is
so strong- strong enough to save one life to five million.