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Cedars-Sinai has been working on two medication-related processes with similar names but different focuses and processes: Heart Failure Discharge Medication Instructions and Medication Reconciliation. To minimize confusion between the two processes, following is a detailed explanation of the two initiatives and processes. One of JCAHO's Core Measure indicators for Heart Failure is Discharge Instructions. Evidence in the literature demonstrates that when patients follow their medication regime correctly at home, there is a lower likelihood of their clinical status declining. To comply with JCAHO Heart Failure Core Measure for Discharge Medication Instructions, Cedars-Sinai must 1) Provide discharge instructions to patients on medications, and 2) The list must be consistent with any other discharge medication list in the medical record, including the dictated summary. To achieve compliance, two steps are required by physicians, effective Jan. 1, 2007: - 1) Upon discharge, physicians must complete and sign the E-Discharge Medication List that is available in Web/VS or in the chart (printed by nursing);
- 2) Ensure that the "E-Discharge Medication List" matches the dictated medication list. To avoid mismatched lists, another alternative is to dictate "Refer to patient list for discharge medications." This list will be scanned into Web/VS and available 48 hours post-discharge. This mandate is not required for patients who expire.
The National Patient Safety Goals are a series of specific actions that the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) expects accredited hospitals to take to help prevent medical errors. One of the National Patient Safety Goals is Medication Reconciliation across the continuum of care -- beginning with admission and ending with discharge. Cedars-Sinai must demonstrate that we have developed a process to ensure that pharmacists, doctors or nurses review a patient's medicines when admitted to the hospital, transferred to another part of the hospital, and discharged. A process has been implemented where the nurse completes an admission medication form for all inpatients and outpatients, and nursing and pharmacy reconcile medications upon transfer within the medical center. We are recommending that the physician complete the Web/VS E-Discharge List that is available in printed form in the chart or available on Web/VS. Completion of the form by the physician is recommended at this time. It is NOT mandatory. We offer clarification that only the CHF d/c medication list is mandatory for completion by the physician at this time.
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