Laboratory directors and pathologists are probably watching the scramble inside hospitals to meet new requirements for “medication-reconciliation.” Medication-reconciliation was first brought up by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) in 2004, when they stated that it would be a goal on their 2005 Hospital National Patient Safety Goals. The goal was as follows:

Goal 8 Accurately and completely reconcile medications across the continuum of care.
8A During 2005, for full implementation by January 2006, develop a process for obtaining and documenting a complete list of the patient’s current medications upon the patient’s admission to the organization and with the involvement of the patient. This process includes a comparison of the medications the organization provides to those on the list.
8B A complete list of the patient’s medications is communicated to the next provider of service when it refers or transfers a patient to another setting, service, practitioner or level of care within or outside the organization.

JCAHO’s timetable, as published, is proving to be too ambitious. A November article in Modern Healthcare has revealed that many hospitals struggled to meet this goal. About 25% of hospitals surveyed by JCAHO were not in compliance by 2006.

Why is it difficult for one-quarter of the nation’s hospitals to achieve this goal? There are several key explanations for the problem. For example, an internal study by Froedtert Memorial Lutheran Hospital determined that pharmacists produced the most accurate list of medication lists. However, it is nurses who typically have this responsibility. This was documented in a study of hospital practices by the Institute for Safe Medication Practices that found that 94% of the time nurses were responsible for collecting the initial medication history and 77% of the time they were responsible for making sure the list was accurate. Hospitals lack the resources necessary to have pharmacists compile these lists. Besides inadequate budgets to pay appropriate staff to compile medication lists, hospitals reported that a major difficulty in compiling accurate lists was that patients simply did not know what drugs they were taking.

Given these widespread challenges, JCAHO’s timetable has provided inadequate time for many hospitals to successfully implement a functional and successful medication-reconciliation plan. One of the shining stars that emerged in the Modern Healthcare article was McLeod Health in Florence, SC. McLeod started instituting its medication-reconciliation program five years ago and it’s still working out the bugs. “At this point, “said Leanne Huminski, associate Vice President of Nursing, “we are perfecting where other hospitals are just starting.”

For laboratory directors and pathologists, the mandate for hospitals to implement medication reconciliation is instructive on at least three levels. First, it is an example of how evolving JCAHO requirements, with ambitious timetables, are designed to push hospital administrators to implement change more quickly. Second, medication reconciliation is directly linked to the national goal of improving patient safety. Third, as the nation’s hospitals successfully fulfill medication reconciliation requirements, it is likely that future initiatives to improve patient safety will begin to utilize more effective use of TDM (therapeutic drug monitoring). Increased TDM testing will require a closer level of support between clinical laboratories and the referring physicians.