Patients: Get Active with Medicine Reconciliation
By: Professor Kevin M. Schuer, MSPAS, MPH, PA-C
Health care delivery is complex. As clinicians, we are inundated with alerts, reminders, new research, updated technology on a daily basis. One can only imagine what the patient must feel like. As a previous fellow with the National Center for Patient Safety, we were educated and trained on the sophisticated principles of health care quality, as well as organizational culture and their impact on how care is delivered. But we also were trained to recognize a very simple, but remarkably important premise: every decision made during my time as a fellow, and now as a clinician, should be made with the patient's best interest in mind. Delivering safe, high quality, efficient, and effective care needed also to be (primarily) about the patient. The Institute of Medicine as well as many other regarded advisors on issues relating to health and medicine describes Patient-centered care as a concept that emphasizes choice, respect, support and empowerment...regardless of profession, gender, race, ethnicity or creed. The model of 'patient-centeredness' is an active process between health care provider and the patient. One method that can not only enhance the provider - patient relationship necessary for patent-centered care, but also work towards the safe delivery of care is through a concept known as 'medication reconciliation.'
Medication reconciliation, as described by the Joint Commission in their 2005 National Patient Safety Goals, is the process by which medications are "accurately and completely reconciled across the continuum of care." Put directly, the medications that are prescribed to you...the ones that you have in your home that you take as prescribed, should be the very same medications (with the same name, dose and frequency) listed at your doctor's office, whether that be in an electronic medical record, or paper chart. The doctor's office, your provider and you (the patient) should all have exactly the same information regarding your medicines. Hospitals, urgent treatment centers (UTC), and outpatient clinics alike have become very good, via electronic mechanisms or otherwise, at ensuring patient's medicines are 100% reconciled. However, unexpected hospital admissions, switching pharmacies, emergency room and UTC visits, where the potential for medication changes exist, happen regularly. This increases the chance of medication errors occurring. Health services delivery research has consistently demonstrated that inadvertent medication errors continue to happen with regular frequency. These errors, which commonly occur due to deficits in communication between providers, facilities, and patients, can lead to serious harm. Physically bringing all of your medications to each and every doctor's appointment, ER or UTC visit, etc and going over each medicine with your nurse, physician, physician assistant, or nurse practitioner is an essential part of each visit.
Active reconciliation of your medications on a regular basis is an absolute essential for patient-centered care. In order for this process to work, both the clinician and patient should hold one another accountable. I am privileged to work alongside extraordinarily bright and caring health care professionals. I am equally as privileged to serve the patients who come through our clinic doors. However, I'm constantly reminded of the need to work together, patients and providers alike, to ensure that care is safe, of the highest quality, effective, efficient, and most of all, patient-centered.
Kevin M. Schuer is a Physician Assistant with UK HealthCare, Assistant Professor in the UK College of Health Sciences, Physician Assistant Program as well as national chair of the American Academy of Physician Assistants (AAPA) Quality Care Working Group.