Many hospitals are still noncompliant on medication reconciliation

September 17, 2007

A recent Institute for Safe Medication Practices teleconference with a surveyor from The Joint Commission highlighted the rigor with which TJC is implementing its medication management standards and National Patient Safety Goals.

"Reconciliation remains a very hot topic out there," said Matthew Grissinger, R.Ph., director of error-reporting programs for ISMP and the teleconference moderator. "We are receiving reports that people from all over the country are struggling with it, especially ownership of the process-who is responsible for what."

The Joint Commission is aggressively pursuing that problem and other medication management issues, said Darryl Rich, Pharm.D., the JC surveyor who conducted the teleconference.

In addition to reconciliation (which is NPSG 8), Rich discussed several JC medication management standards, including storage, ordering, and pharmacist review. Those three standards scored the highest in noncompliance in 2007-42.1%, 21.5%, and 10.3% of surveyed institutions, respectively. With regard to each of them, failure to comply with in-place internal polices was of primary concern. "We see it again and again," said Rich.

Storage (MM 2.20): Inappropriate and unsafe storage is especially prevalent in radiology, cardiac cath labs, operating rooms, and emergency departments, Rich said. "The [noncompliance] problems related to storage almost always occur in nonpharmacy areas," he said. "Pharmacists need to find out where drugs are requisitioned, and they need to go there. The only way to find how drugs are being stored is if it's done right in front of you."

Review (MM 4.10): Pharmacist review should occur for all medication orders except in urgent situations and when a licensed independent practitioner (LIP) is present "at bedside," said Rich. Of particular concern is the administration of contrast media in radiology departments. Rich said that an "opportunity for improvement" in virtually all organizations is the retrospective review of sampling records where contrast media were administered without prior pharmacy review-in order to determine if the system is working as designed. "This is universally not done," he said.