JCAHO tightens leash on medication reconciliation

Dissatisfied with the attention hospitals have been giving to medication reconciliation, the Joint Commission on Accreditation of Healthcare Organizations has issued a sentinel event alert, signaling the high priority it's placing on this issue.

The alert follows an earlier decision by JCAHO to select medication reconciliation as its 2005 National Patient Safety Goal #8. Unveiled in July 2004, it required accredited organizations to develop and test processes for medication reconciliation in 2005 to be implemented by January 2006. The goal is to "accurately and completely reconcile medications across the continuum of care."

JCAHO explained that it is targeting medication reconciliation because poor communication of medical information at transition points is responsible for 50% of all medication errors and as many as 20% of inpatient adverse drug events.

Today, a number of healthcare organizations have taken dramatic steps to reduce medication errors, and many are calling upon the expertise of their pharmacists to lead teams to revamp their medication reconciliation procedures and help ensure JCAHO compliance.

Pharmacy technicians at one hospital, for example, reduced potential adverse drug events by 80% within three months by obtaining medication histories of patients scheduled for surgery, according to JCAHO.

"Although these specific initiatives were put into the safety goals at the beginning of 2005, obtaining a complete list of a patient's current medications has been a requirement in the agency's medication management standards for several years," noted Richard Croteau, M.D., executive director for JCAHO's Patient Safety Initiatives. "A lot of people don't realize that, so we are now more explicit in the use of that list.

"The standards state that healthcare providers should have a complete list of the medications a patient is currently taking before they prescribe new medications," Croteau said. "Now, we detail how to use that information [with every medication order] to compare against what's being ordered and communicate that information to the different providers of care."

Group's model plans

In a wide-sweeping effort to enhance medication reconciliation procedures and comply with the recommendations, a number of organizations are working closely with the Joint Commission and developing initiatives to assist facilities in creating new guidelines and protocols.

"We have recognized the importance of medication reconciliation, and each of us includes that as a major initiative in our respective programs," explained Croteau. "The collaboration is to align our specific expectations in those initiatives so that hospitals won't be trying to respond to different sets of requirements.

"This is not always easy to do but it significantly increases the chances of success in implementing something like this," said Croteau. He has been collaborating with organizations like the Institute for Healthcare Improvement (IHI) in Cambridge, Mass., and the Massachusetts Coalition for the Prevention of Medical Errors in Burlington.

IHI, for example, has made medication reconciliation a key component of its 100,000 Lives campaign, a nationwide initiative to help hospitals improve patient care and prevent avoidable deaths. The IHI Web site, http://www.ihi.org/ includes a section on medication reconciliation review, including samples of a reconciliation tracking tool and a medication reconciliation flowsheet.

"Our goal is to find ways to energize hospitals across the country to develop an infrastructure," said Frank Federico, director of IHI, who is also a pharmacist. "We want to bring hospitals together so they can learn from each other. Many organizations like the Joint Commission have joined us and said this is the right thing to do. That has brought people together where we didn't do well before."