NurseWilliam, at 7:48 PM  

JCAHO has run amok. They have changed from being an effective and valuable patient advocacy organization to being just another bureaucracy that hands out rules for their own sake.

 NurseWilliam, at 8:15 PM  

Hypnokitten, my previous post was a more visceral response to the problem. Sine I am an ER nurse, please allow me to provide some insight into the problem.

Since May of 2006, our ER management has created a 3-copy medication reconciliation form that ER nurses are required to fill out. One copy goes upstairs if the patient is admitted. One copy goes to the patient. One copy is kept for ER records.

The number of patients who come to my ER with up-to-date medication information is probably less than 5 percent. The rest rely upon memory, which is sketchy at best. Some remember the names of all their medications, but not the doses. Others remember that, but not the frequency.

What we get, more often than not, is a sick person telling us that they take "a blue pill," "another pill for my cholesterol," "a water pill," and a "pill for pain." I work the night shift. Guess how many pharmacies are open at 1AM. Maybe one or two. Since not everyone goes to that pharmacy, it's impossible for us to get a record from them in a timely manner.

Regarding family: unless the family member also happens to be the caregiver, forget accurate medication lists. Even family members who have Power of Attorney are clueless about what their loved one is taking.

So where does that leave ER nurses? Well, in a perfect world we would find all the information and provide an accurate and up-to-date medication list that the patient can slip into his or her pocket for future reference. Of course, ER nurses are already up to their armpits with high-acuity patients who often require immediate intervention and attention.

So in the real world, the list is done for those patients who are being admitted, and then only if the patient has accurate information. We can only give what we can get.

I am a huge proponent of providing patients with the means of keeping accurate medication lists. It's to their benefit, since it allows them to give medical staff information that we can use to in turn provide care that is tailored to their specific needs. But the JCAHO mandate sets up an impossible situation for us in which we must give paperwork first priority and patient care second. For that reason alone, there is not a single ER nurse in this country who has gone with this mandate without vociferous protest.

 HypnoKitten, at 11:54 PM  

I recieved that request to participate in the survey from a group of nurses who forwarded it to me. Even though I don't work in an ED, our psych hospital is considered emergency treatment and we also have to fill out med reconciliation lists. I suppose it's lucky for us that our pts stay at least a few days rather than a few hours, and we can check on things in the morning when outpatient docs and pharmacies are open.

I posted that because I do feel what JHACO is attempting is short-sighted, bureaucratic, and just another excuse to have more meetings. Do they really have nothing better to do?

The poll is turned off now, but I hope that as nurses we all can stay updated on changes (for better or worse) that can impact the way we do our jobs and, ultimately, provide patient care.

-HK