ISMP Survey on Medication Reconciliation

Table 3. Excerpts of Edited Respondent Comments about Medication Reconciliation  

We have spent more time on the forms and the process than any other safety project. We have also had to increase staffing in pharmacy without reimbursement from insurance or another payer.

This is a very hard process to implement, regulate, and track in our facility. Some of the NPSGs were very straight forward, this one is not. While I think most of our staff feel it is important and do some level of reconciliation, the process is still foggy.

This is a complex process that, when applied universally, creates points of contention with the medical staff, especially surgeons. Unfortunately our Information System vendor is not providing the solutions required.

Policy makers have not obtained valuable input from the nurses and physicians. The result is a complicated, disjointed, and time consuming process in which compliance is low.

It’s hard to reconcile medications when the patient's doctor’s office is closed and the patient obtains medication through a mail order service.

Until there is a national database for patient medication histories, medication reconciliation will be continue to be problematic for all.

We had an interdisciplinary team implement the process, but it seems like every unit is different and has its own cultural reaction to the change.

We still struggle with this whole process. We need to come up with a way to get medical staff fired up over this.

The medication reconciliation goal is important to patient safety, however the information rises and falls on the information the patient provides to the health care team. There needs to be a major advertising blitz on the television and radio asking people to put together an accurate list of their medications. Physicians, nurses, and pharmacists at our hospital see this goal as very burdensome and time consuming.

It would have been much easier if computerized software for medication reconciliation had been perfected before implementation. There is too much paperwork and duplication now. We had to designate one nurse to oversee medication reconciliation per shift.

Leadership and providers don't agree with the necessity of medication reconciliation. Therefore our current process meets a very superficial "check the box" requirement for inspection purposes only. It is a far reach from doing the right thing!

The intent is admirable, but in reality, the nurse is doing all of the leg work. Pharmacy and physicians take no ownership of the process.

Unfortunately, many of the nursing staff consider this to be low priority – they are "too busy." Until nursing leadership makes it a priority for nurses, and hospital administration makes it a priority for physicians, I fear we will swim in circles on this issue.

I really feel that the initial reconciliation on admission is an accident waiting to happen. We have had some severe near misses. The physician takes these reconciliation sheets as gospel. Something needs to be fixed????

Communication between facilities and retail pharmacies is poor at best, and would benefit if a formalized universal method of communicating med profiles can be instituted preferably via electronic processing.

This is a very important issue, but complicated by many factors outside the control of the acute care hospital. These problems (e.g., obtaining an accurate medication history) clearly demonstrate the need for a central organized database of patients’ medical histories.

I know this is needed, but it is very stressful trying to get it done along with all the other safety issues and caring for other patients. Many medical patients are on huge lists of medications. Patient acuity is higher than ever. To make this happen, I think the government should be looking at ways to reimburse hospitals for this process so more staff could be hired to make this happen.

I think that faculty in universities should also be learning about this initiative, in order to introduce the concepts to their students.

The toughest part of this process is getting everybody to agree that correct execution is worth the time it takes to implement. We are still in the formative stage, and it's been six months.

A resource intensive process to start, this will take a culture shift to get everyone on board. This is a journey that will take at least 12-24 months to get significant measurable results.

I think this process will take two years to arrive at something that is workable and consistent for all hospitals and benefits every patient.

Perhaps JC will at least give healthcare systems a little more time.

Before reading this I had no idea what medication reconciliation was. Thanks for making me more knowledgeable.

I may never know, but I am sure I have prevented medication errors in the home by completing medication reconciliation.