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ED Accreditation Update
TJC changes policy on med reconciliation
In the latest move in the continuing saga of the National Patient Safety Goal (NPSG) on medication reconciliation, The Joint Commission has said while it will continue to evaluate compliance with the standard during on-site surveys, "it will not be factored into the organization's accreditation decision and will not generate Requirements for Improvement [RF])." The new policy, announced recently, became effective retroactively to Jan. 1, 2009.
The Joint Commission noted in its announcement "the difficulties that many organizations are having in meeting the complex requirements of NPSG 8."
The shift was good news for ED managers. "I'm excited," says Kirstie M. Tindale, BSN, clinical manager of the ED at St. Francis Hospital in Tulsa, OK. "It's helpful to not get 'dinged' on it because it's hard. It's been very difficult to implement." Tindale remains cautiously optimistic. "I'm sure they will change their minds," she predicts.
That caution is well advised, notes Louise Kuhny, RN, MPH, MBA, CIC, The Joint Commission's senior associate director of standards interpretation. "We would encourage continued diligence," she says. "All the experts would agree, and health care workers would agree, that there is risk to patients if medication reconciliation is not carried out appropriately. To omit or duplicate medications or to prescribe something that is contraindicated can have bad consequences."
What The Joint Commission actually reassesses is a department's method of reconciliation — not whether they do it, she says. "Organizations should still be prepared to explain to surveyors what processes they have in place," Kuhny says.
It would be unfair for The Joint Commission to expect total compliance, Tindale argues. "We've made significant headway and we've done better; but until there is a requirement that all pharmacies and hospitals be linked in a [computer] network, actual medication reconciliation will always have less than 100% compliance," she says. "For our ED, our problem is getting that information up front; half of our patients do not remember medication doses or names — they might remember the colors — and we, as ED staff, do not have time to call all their pharmacies."
A couple of St. Francis' ED physicians previously worked in facilities in other states where EDs had access to statewide databanks linked up to every pharmacy. "You just typed in the patient's name and birth date, and you could get a full list of their meds," Tindale says. "That's what we need."
Kuhny agrees, to a point. "I think obtaining a list from the patient is definitely one of the most challenging standards for the ED, and an electronic system would be a definitive solution, but it's only one piece of a big puzzle," she says.
ED Accreditation Update
What should EDs do while TJC 're-evaluates'?
Even as The Joint Commission announced that it would cease to factor compliance with the National Patient Safety Goal on medication reconciliation into its accreditation decisions, it reminded all interested parties that final language on the goal is far from complete.
"The Joint Commission will be evaluating and refining the expectations for accredited organizations pertaining to medication reconciliation," it stated when announcing the policy change.
Where does that leave ED managers? How do they proceed with compliance programs when they're not entirely sure what it is they are supposed to be complying with? Louise Kuhny, RN, MPH, MBA, CIC, The Joint Commission's senior associate director of standards interpretation, admits she gets a lot of questions from hospitals about programs they were planning to change or improve. "Our position is that if they had plans in place that required resources and they are convinced those plans would positively affect patient safety and quality, we would encourage them to go ahead with their plans," she says. "But if those plans are being done for the purpose of accreditation, and they are not necessarily convinced those particular changes would improve patient safety and quality, then we would encourage them to hold off until we make a new decision."
Kirstie M. Tindale, BSN, clinical manager of the ED at St. Francis Hospital in Tulsa, OK, says, "I don't intend to change anything. For myself, I prefer to still consider it something we need 100% compliance on, because we do."
Until The Joint Commission more clearly defines what they want, no one will be completely sure what is being evaluated when surveyors visit, she points out. "But any clinical people who sit down and give this serious consideration should know what medication reconciliation should entail — that you do it for every point of change the patient makes in their care," Tindale says. "That speaks for itself."