Revised safety goal on medication reconciliation

HSE insomnia


Medication reconciliation is a topic that pharmacists know well, and trying to meet the intent of the Joint Commission’s initial National Patient Safety Goal (NPSG) for it caused much insomnia. Being compliant with the revised NPSG on medication reconciliation may still keep many pharmacists awake at night.

Setting the goals

The Joint Commission established the NPSGs in 2002 to help accredited organizations address specific areas of concern regarding patient safety. The NPSGs are developed through a Patient Safety Advisory Group comprising recognized patient safety experts with front-line, hands-on experience from a wide variety of health care settings.

The purpose of the NPSGs, very simply, is to improve patient safety. The goals focus on problems in health care and ways to solve them. Most of the NPSGs apply to all types of accredited facilities, although some are more specific to certain locations, such as the NPSG to prevent health care–associated pressure ulcers, which is specific to long-term care facilities.

Each year, based on the recommendations of the Patient Safety Advisory Group, the Joint Commission sets the NPSGs. Over time, many of the standards that were once NPSGs may be retired as such but may be incorporated into other Joint Commission standards.

NPSG on med rec

Pharmacists are very aware of the importance of medication reconciliation. Many studies have shown that significant medication errors can occur at transitions of care, such as at admission or discharge from the hospital. Because of the prescriptive nature of the original NPSG, it was difficult for many facilities to meet its requirements.

In 2010, the goal was suspended and revised, based on input from many national health care organizations. The revised goal is now in place, and Joint Commission surveyors began scoring this NPSG in July 2011. The process has been streamlined to include the following steps:

  • Find out what medications a patient is taking at home.
  • Compare this home medication list to any new medications given in the hospital.
  • Address any discrepancies between the two lists.
  • At discharge, give the patient a list of medications and education about those to be continued at home.

This process sounds simple, but pharmacists know how complex it can be, as many patients take multiple medications from multiple providers and may not have any kind of accurate medication list. The Joint Commission realizes the potential difficulties of medication reconciliation and expects the hospital staff to make a “good faith effort” to obtain an accurate list of home medications.

The current home medication list must be compared with any new medication that is prescribed and any discrepancy must be resolved. Each facility will determine who “owns” this process, but many are determining that the health-system pharmacist is the best qualified for this responsibility.

Communication is key

Good communication must take place among all providers so that the list of medications provided to the patient to take at home after discharge is complete and the patient and caregiver have been educated and understand the discharged medications. This NPSG highlights the necessity of helping patients keep an updated list of medications with them at all times.

NPSGs are another way that the Joint Commission helps accredited organizations keep patient safety at the forefront of their quality activities. When pharmacists put patients and their appropriate medications first, meeting this NPSG should not cause insomnia.