In the many years I walked the halls of the skilled nursing facilities where I worked as regional manager, I saw residents go through a revolving door from facility to hospital and truly experienced the “reducing rehospitalization” issue first hand. While I don’t have all the answers, there is one area of the transition of care from hospital to post-acute that I believe truly impacts the rehospitalization rates we and our soon-to-be acute care partners need to figure out fast … and that is medication reconciliation.
Transitions of care occur throughout the entire long-term care continuum, which includes skilled nursing facilities, assisted living facilities, home health care, and hospice, among others. Getting it right is critical. Poor transitions of care are the leading cause of medical errors. They result in adverse events, avoidable complications, increased hospital readmissions, duplication of services, and wasted resources.
According to recent studies, 49% of hospitalized patients who are discharged experience at least one medication error within 60 days of leaving the hospital—frequently while in the common 30-day post-acute period. Do you see the potential for finger pointing at your facility? Further, approximately 60% of medication errors occur during a transition. Many of these are related to changes to the medication regimen that occurred in the previous care setting. There are several different reasons why changes in medication occur; one distinct cause is formulary restrictions.
Each care setting has a unique formulary of medications that are preferred for use. Many times when an individual transfers from one care setting to another, the medication must be changed to correspond with the new care setting’s formulary. Without a proper transition of care, this can result in duplication of medications.
Medications change frequently when a resident moves from one care setting to the next. And it’s confusing not only for the residents and their loved ones, but also for the post-acute care giver. Communication about medication at the moment of transition of care is one of the top lines of defense to reducing hospitalization caused by errors in med reconciliation. Even more serious is that not only will that med reconciliation error send your resident back to the hospital, but it could have a critically negative impact on the resident’s health and thus become a huge liability risk for you, the provider.
As acute and post-acute care providers move to a value-based health care system as dictated by the Affordable Care Act, we’re all going to be looking very closely at our partners. Wouldn’t it be nice to be able to have a system in place to demonstrate your ability to ensure accurate med reconciliation? Just follow these steps as a resident is being transferred to your facility:
- Ensure that you receive a list of current medications.
- Obtain a list of all prescribed medications.
- Compare both lists and ask questions to reconcile the two.
- Make a decision regarding which meds to continue based on medical judgment, patient condition, and patient history.
- Communicate the med list to all caregivers, family members and the resident.
We are providing care for more acute residents in our facilities. There are many factors we as providers need to consider in order to prevent rehospitalization, and one of the most important is proper med reconciliation. Look at the systems you have in place and provide training to your staff. Using good med reconciliation techniques avoids medication errors such as omissions, duplications, dosing errors, and/or drug interactions. This should be done with any transition of care—whether it is between locations, between providers, or between different levels of care.
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