6/27/07

Medication reconciliation

Do you think medication reconciliation works in the ER?

Giggles comes in from home. She lives alone with a caregiver that comes three times a week but didn't accompany her to the hospital. She is a very vague historian, has no clue what med's she takes or what pharmacy she gets them from. She gives me her physicians name so I put in a call to his office. Three calls and much time on hold later I finally get in touch with the medical assistant who is finally able to tell me that the patient is not theirs. Close to 45 minutes wasted and still no clue what medications she is on. He last hospital record is from three years ago and she was admitted by the hospitalist then. I could start randomly calling pharmacies but there are 39 of them in the area and that would take hours.

Nice mid sixties gentleman comes in with Chest Pain. He knows he takes a blood pressure pill, a water pill and something for his sugar, not the names or the dosages. He gets his med's through the mail from the VA. I don't know about where you work, but I could part the Red Sea easier than I could get that information from the VA.

A 77 year old lady comes in with all her pills (14 different kinds) helpfully arranged in a pill box. It is midnight and her pharmacy and doctors office is closed. It takes over an hour with the identidex system and help from the pharmacist to identify 13 of them. The last one is an alien pill that denies definition and she has no idea what it is for.

Who has time to spend doing this nonsense. Tracking down the elusive med list, the ambulances keep coming, starting IV's, titrate pain meds, do EKG's, start foleys, gastric lavage, restrain and monitor psychotic patients, talk to familys, take admit orders over the phone, arrange to get my patients upstairs and so on and so on. Spending hours trying to track down a med list that is one or two or three people that are sitting in the lobby waiting for a bed or a sick patient who's not being taken care of isn't going to work.


Nurses need to be at the bedside. Period.

3 comments:

  1. I hear ya, I hear ya! "I take the blue pill in the morning and the white one with lunch". It's important to know what meds they take so what is the solution? Our ER has an Admit Nurse. It's her job to follow up on the med recon when the patient doesn't have the oh-so-wonderful typed up list in their purse. It's also her job to take orders for admission and arrange for the patient to go upstairs. She also fills in the pain in the butt admission data base. She is a goddess and we bow down at her feet...

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  2. We use pharmacy residents (studnets) to do our medication reconcilliation on all of our admitted patients. It works well for us!

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  3. I WORK IN A RURAL ED SO IT IS UP TO THE 2 NURSES WORKING TO FIGURE THIS OUT AND WE DO THE BEST WE CAN BUT SOMETIMES AGAINST ALL ODDS WE JUST HAVE TO SAY TO HECK WITH THIS!!!!!

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