All Entries Tagged With: "medication reconciliation"

Joint Commission announces revisions to medication reconciliation goal

Medication reconciliation has received a face lift: revisions to the medication reconciliation National Patient Safety Goal (NPSG) have been approved for implementation as of July 1, 2011. The Goal, NPSG.03.06.01 (formerly NPSG.08.01.01) has been altered based on feedback The Joint Commission has gathered that indicated the Goal was too prescriptive and detailed to be implemented effectively.

The changes affect the ambulatory, behavioral health care, critical access hospital, home care, hospital, long term care, and office-based surgery accreditation programs.

Intent to update or improve medication reconciliation requirements began in at the beginning of 2009, when The Joint Commission announced it would begin an analysis and review of the NPSG, and would not include medication reconciliation findings into survey results.

Medication reconciliation remains under the National Patient Safety Goal chapter of the Comprehensive Accreditation Manual, but has been moved under a new number (NPSG.03.06.01).

For more information, visit The Joint Commission’s Web site.

Med rec implementation postponed again–what is your organization’s process?

Earlier this month The Joint Commission announced that it again would be pushing back the implementation date for changes to the medication reconciliation process, formerly National Patient Safety Goal (NPSG) 8  and proposed as NPSG.03.07.01 during the field review process. In its June 2 Joint Commission Online the accreditor said that through the field review process it became apparent that although organizations think that getting a handle on medication reconciliation is important for patient safety, they do not think it is fair to comply with a NPSG or standard that holds them responsible for matters out of their control. These “matters” might include collecting an accurate list of a patient’s medication from patients who do not know all of the medications they are taking. Or communicating to the patient’s next provider of care the patient’s medication list at the time of discharge–often the next provider of care is not known.

The field has been complaining about the actual NPSG concerning med rec since its institution years ago because of its impracticality. Now The Joint Commission is saying that the newest form of requirement may come in the general standards, and not the NPSGs, and it will not be ready for implementation until July 2011 at the earliest.

I’d like to hear from you readers about how you’ve been handling medication reconciliation in the absence of any clear cut regulations from The Joint Commission. Of course there are general best practices out there, and that is likely what many of you are following. What are those? How has your hospital been reconciling patients’ medications?

ASHP to The Joint Commission: Good steps taken in proposed revision to med rec

The American Society of Health-System Pharmacists (ASHP) has posted on its website its feedback to The Joint Commission’s proposed revisions to the medication reconciliation National Patient Safety Goal. Overall ASHP’s comments are that the changes made are positive ones, and that it is happy the accreditor has given hospitals more flexibility in implementing their own processes to comply with the goal.

At this time, the goal has just finished a field review and The Joint Commission is presenting the proposed goal to its The Joint Commission’s Standards and Survey Procedures Committee. The proposed goal pares down four goals with 13 elements of performance (EP) to one goal with five EPs. Notably missing is the requirement to provide a patient’s medication information to the patient’s physician or next provider of care. You can find more about the proposed goal in this earlier Patient Safety Monitor Blog post.

The accreditor is expected to announce the final version sometime in the coming months, with possible inclusion in the 2011 standards. The Joint Commission said that it has moved the location of the goal from its original location at goal 8 to goal 3, with the rest of the medication safety language.

For the most part, ASHP’s statement says that the organization agrees with The Joint Commission’s goal as written. However, some of ASHP’s specific recommendations include:

• Changing “obtain information” from the patient regarding medications to “obtain a medication list” to make the requirement more specific and useful.
• Further clarifying the definition of medication.
• Ensuring that the hospital collects at a minimum  the name, dose, route, and dosing frequency of each drug, at a minimum.
• Comparing the patient’s medication list with the list of medications ordered for the patient in the hospital, and resolving those differences.
  
• Not only giving the patient a written list of the medications he or she should be taking upon discharge, but counseling the patient on taking his or her medications, to allow for questions.

You can find ASHP’s full comments on the proposed goal here. Did you submit feedback to The Joint Commission regarding the proposed goals? Do you have any specific feedback you would like to share on the PSM Blog?

Joint Commission announces field review for med rec

The Joint Commission has announced the field review of its revised medication reconciliation requirement, which it has designated as National Patient Safety Goal (NPSG) 03.07.01.

The field review comes after The Joint Commission announced it would make the existing medication reconciliation goal (NPSG one with which hospitals had to comply, but about which they would not be surveyed. The 2010 NPSGs contain language about medication reconciliation, but the field has widely expected an announcement about what will become of the goal.

The accreditor had previously said it would update the goal because it had received feedback from the field indicating that hospitals felt the goal was too difficult to implement. Last February, The Joint Commission said it would “evaluate and refine the expectations for accredited organizations.” The field review is the result of this refinement.

The revised goal is designed to work in tandem with other medication management requirements. It requires providers to maintain and communicate accurate information regarding a patient’s medications. Specifically, the goal would require hospitals to:

• obtain medication information from patients at admission
• compare that information with the medications ordered for the patient and identify discrepancies
• communicate to the patient at discharge information about the medications he or she should be taking
• impress upon the patient the importance of managing his or her medications outside of the facility.

The Joint Commission is asking for feedback from the field through May 11, although it would prefer feedback by April 30. The standard will be tested in the field prior to implementation. If you’d like to offer your feedback, and to see the full text of the proposed goal, visit The Joint Commission’s page about the field review.

Do you have any initial reaction to this proposed med rec goal? My sense from the field that any change would be a good one, and this seems to really simplify the goal.

Field review of revised medication reconciliation NPSG postponed

Field review of National Patient Safety Goal (NPSG) 8, regarding medication reconciliation, has been postponed to later in the year. Originally planned for February, the field review has been moved so that the Joint Commission advisory and board committees can review a draft of the revised Goal.

We originally reported last February on the Patient Safety Monitor Blog that the Joint Commission had decided to make the med rec Goal one with which hospitals had to comply, but about which they would not be surveyed. The 2010 NPSGs contain language about medication reconciliation, but the field has widely expected an announcement about what will become of the Goal. The Joint Commission has not announced when it will release the 2011 NPSGs and if they will contain any other changes (in addition to those made to the med rec goal).

How has your facility been handling medication reconciliation since The Joint Commission backed off surveying the Goal’s requirements?

You can find The Joint Commission’s announcement about postponing field review here.

A do-over for med rec?

After three years of struggling with The Joint Commission’s National Patient Safety Goal 8 on medication reconciliation, hospitals will get a break in the near future. The accreditor appears to be re-thinking the goal, which has been in place since the 2005 edition of the NPSGs.

In an announcement sent yesterday to CEOs and survey coordinators and later posted online, the Joint acknowledged the difficulties hospitals have had meeting the goal and it would ”evaluate and refine the expectations for accredited organizations.” In the meantime, survey findings from NPSG 8 will not be factored into accreditation decisions and survey findings on med rec will not generate Requirements for Improvement and will not appear on the accreditation report. 

The Joint Commission says it still expects hospitals to address med rec within their organizations. During on-site surveys, Joint surveyors will continue to evaluate the organization’s med rec processes, discuss opportunities for improvement, and collect progress updates.

The accreditor plans to consult with healthcare organizations, physicians, pharmacists, nurses, surveyors, and other stakeholders on the issue in the hopes that it can implement an improved NPSG 8 in 2010.

Is this a smart move by the Joint Commission? Does your organization successfully handle the med rec process? Let us know in the comments section.

UPDATE: Check out some reaction from the field at the AHAP blog.