Starting in July, hospitals, nursing homes, office-based surgical practices and other health care organizations accredited by the Joint Commission will need to comply with new requirements for medication reconciliation.
Officials at the Joint Commission have approved a revised national patient safety goal on medication reconciliation that requires providers at accredited organizations to find out what medications patients are taking when they are admitted to the hospital or arrive at the facility, and compare that information with any new medications ordered. Providers must also give the patient or family a list of the medications that should be taken once they leave the facility.
The Joint Commission is also asking providers to do something new: Educate patients and their families about the importance of maintaining a list of current medications. For example, hospital staff could fulfill this goal by advising patients to give the reconciliated medication lists to their primary care physicians.
The Joint Commission’s requirements differ somewhat depending on the setting of care. For example, in settings where medications are not prescribed, providers will not be required to compare old and new medications, or to give patients written information on the medications they should be taking. They will also not be required to provide education on medication management.
These new requirements replace a national patient safety goal on medication reconciliation from 2009, which was placed on hold due to concerns from physicians and hospitals that it was too prescriptive. Since then, officials at the Joint Commission have been talking to physicians and other providers about their concerns, and working to revise the requirements.
"We really tried to work with the field to find out what the goal should be all about," Maureen Carr, project director for the division of health care quality evaluation at the Joint Commission, said in an interview.
Ms. Carr said the previous medication reconciliation goal was much more prescriptive and included requirements related to several elements of the care process that were already addressed in other Joint Commission goals. This time around, officials tried to simplify the requirements by focusing on "risk points" associated with medication reconciliation. They also tried to minimize the documentation requirements.
And they backed away from some of the more prescriptive elements, Ms. Carr said. For example, the goal used to require that providers give the reconciled medication list to the next provider of care. But that was problematic because in some situations there wasn’t a next provider of care, she said. Now the requirement is to give the list to the patient or family. "We’re trying to take away some of the things that were unnecessarily prescriptive," she said.
The revised goal also spells out that making a "good faith effort" to get an accurate medication list would meet the intent of the standard. Officials at the Joint Commission understand that it’s difficult to get a correct medication list from patients for a number of reasons, ranging from patients who withhold information to those that simply forget, Ms. Carr said. It has been the position of the Joint Commission that a good faith effort is enough, but they decided to make that explicit in the policy, she said.
While the burden on providers should be lessened under the revised goal, Ms. Carr said it still addresses patient safety by targeting the most critical areas. For example, the new requirements focus on getting information from the patients when they come in, comparing current medications with new ones, and ensuring that patients understand their medications when the episode of care is over.