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Hello, fellow student nurse.
What are you doing? I'm about to give regular insulin.
You're about to give regular insulin?
I am about to give regular insulin.
You're about to give regular insulin that is cloudy.
I am about to give regular insulin that is cloudy.
You do know that regular insulin is not supposed to be cloudy?
I do know that regular insulin is not supposed to be cloudy.
Oh. Maybe I should recheck the five rights.
Medication reconciliation
is the process of comparing a patient's list of drugs presently taken with those
listed in their record or prescribed orders.
In the book "Patient Safety and Quality" Barnsteiner points out that more than forty
percent of medication errors occur due to poor reconciliation.
Thus medication reconciliation is a significant public health issue
in that portion of the population that takes medicine.
This should be an ongoing concern of both professionals and consumers
Compare
the patient's prescriptions to the medications that the patient has actually been taking.
Avoid medication errors including omissions, duplications,
dosing errors,
drug-drug interactions, or drug-disease interactions.
Repeat at every transition of care in which new medications are ordered or
existing orders are rewritten.
Transitions in care include changes in setting,
service, practitioner, or level of care.
Here are five steps to follow.
Number one:
Develop a list of current medications, including over-the-counter drugs.
Two: Develop a list of medications to be prescribed.
Three: Compare the medications on the two lists.
Four: Make clinical decisions based on the comparison. And, five,
communicate the new list to appropriate caregivers
and to the patient.
"Healthy People 2020" -- available at healthypeople.gov --
is the latest update of the initiatives for national health promotion and disease
prevention which grew out of the 1979 Surgeon General's
report.
It sets objectives and benchmarks and includes goals that directly address
the issue of medication reconciliation.
The Medical Product Safety objectives for 2020
include promoting better health for Americans
through the appropriate use of drugs.
Proper reconciliation strengthens these objectives by supporting the safe
use and close monitoring of medications.
Public health nurses can be effective in promoting medication reconciliation
through Public Health interventions.
The Minnesota Department of Health describes public health nursing
as "the synthesis of the art and science of Public Health and Nursing."
Thus PHN's use strategies from both in their professional practice.
No matter the setting in which they work,
all public health nurses use a foundational set of interventions.
This intervention model --
the intervention wheel --
identifies public health nurse practice
by level of practice and type of intervention
rather than by the location of service.
The inner wheel here illustrates three levels of practice;
individuals and families that make up communities;
communities; and the systems that impact those communities.
Actions which public health nurses undertake are arranged around the outer edge of
the wheel representing seventeen public health interventions.
Many of these interventions may be applicable in our efforts to improve
medication reconciliation,
and one obvious action is that of Health Teaching.
From the Minnesota Department of Health,
health teaching seeks to influence
knowledge, attitudes, values, beliefs, behaviors, practices, and skills.
It can be applied across all levels of practice.
Specifically, the importance of medication reconciliation
can be taught
(or retaught) at every level and at multiple points of contact.
Points of contact are those opportunities that we have to perform medication
reconciliation
and include any combination of:
hospitals,
clinics,
doctor's and dentist's offices,
pharmacies,
long-term care facilities,
schools,
places of worship,
prisons and jails,
and within private homes.
In Healthy People 2020, the U.S. Department of Health and Human Services
supports the use of health information technology including
electronic medical records,
digital prescribing,
and decision-support software.
They recognize that widespread use of these tools should help to reduce
medication errors, improve communication,
empower consumers,
and enhance surveillance to identify adverse effects.
Meanwhile the AMA Center for Patient Safety offers other tools that may be
more easily adapted for immediate use at very low cost,
including a downloadable checklist,
a card which a patient can carry,
and, yes,
There is an app for that!
Prior to implementing any new program
we need to include
considerations for HIPAA compliance
cultural concerns
concerning privacy or expectations of patient-professional roles
and keep in mind barriers such as costs
to rolling out a new program
as well as
perceived or actual workload of current health care providers.
Given the potential harm medication errors can inflict,
and the scientific support for safe use of medical products
it should be clear that medication reconciliation
is a public health issue
worthy of our active support.