RE: Medication list: Hospital-based outpatient practices MORE INFORMATION

[Guest guest]

Thanks to all who have responded to my question; great information!

Now let me add a bit more detail: As noted, this med list process was

begun as a result of a Joint Commission survey. However, our hospital

is now surveyed under an organization called DNV which bases their

surveys on (1) CMS regulations, mirrored in NIAHO (National Integrated

Accreditation for Healthcare Organizations) standards, and (2)

conformity to our own policies. Our policy was created after the JC

survey, but I can find no other standard or regulation that requires it.

I do believe that the JC standard was created as part of a safety

initiative, but--this is my opinion--for therapy practices it really

adds nothing to patient safety.

So here are my refined questions: Are any DNV-accredited organizations

still gathering the med list for outpatients, and if so why? And... for

any hospital-based practice that does gather the information, do you

think that this process in any way adds value in terms of safety,

planning care, or in any other dimension?

Bob Perlson

Director, Rehabilitation

Rogue Valley Medical Center

Medford, Oregon

bperlson@...

http://bpsrehabblog.blogspot.com/

Re: Medication list: Hospital-based outpatient practices

I believe the JC standard that covers this is RC 02.01.07. I've copied

it below.

Program: Hospital

Chapter: Record of Care, Treatment, and Services

Standard: RC.02.01.07: The medical record contains a summary list for

each patient who receives continuing ambulatory care services.

Rationale: (None)

EPs

1 A summary list is initiated for the patient by his or her third visit.

2 The patient's summary list contains the following information: - Any

significant medical diagnoses and conditions - Any significant operative

and invasive procedures - Any adverse or allergic drug reactions - Any

current medications, over-the-counter medications, and herbal

preparations

3 The patient's summary list is updated whenever there is a change in

diagnoses, medications, or allergies to medications, and whenever a

procedure is performed.

I oversee several hospital based OP clinics and in addition to

collecting a med list at the time of the eval. we recently began asking

patients at each visit whether there had been any change in their

medications etc. since they were last seen. In item number 3 above it

states " whenever a procedure is performed " . This, according to our

quality and HIM managers includes therapy interventions.

Sharon

>

> This is a question for those of you who manage hospital practices.

First a bit of background: Several years ago during a Joint Commission

survey, we were directed to obtain a medication list from each

outpatient, and to check the list's validity at each subsequent visit.

(With additional documentation to prove we've done so, of course.) I

can find nothing in the CMS regulations, state practice, professional

standards, or other regulatory bodies that require this in ambulatory

settings.

>

> So here's the question: Are any of you doing this, and if so, why?

Does anybody know of a regulation or standard that I might have missed

that does require this in hospital outpatient settings? Conversely, can

anybody state definitively that this is not required?

>

> Bob Perlson

> Director, Rehabilitation Services

> Rogue Valley Medical Center

> Medford, OR

> bperlson@...

>

> http://bpsrehabblog.blogspot.com/

>

----------------------------------------------------------------------

NOTE: The information contained in this message may be privileged and

confidential and protected from disclosure. If the reader of this message is not

the intended recipient, or an employee or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify us

immediately by replying to the message and deleting it from your computer.

E-mail has the potential to have been altered or corrupted due to transmission

or conversion. It may not be appropriate to rely upon this E-mail in the same

manner as hardcopy materials bearing the author's original signature or seal.

Thank you. Asante® Health System

[Guest guest]

Hi Bob,

Sorry to veer off your main point here but I'll have to respectfully disagree

with your statement that checking, updating and maintaining a medication list

adds " nothing " to patient safety.

500 people per day die in American healthcare due to preventable adverse

incidents and 1.5 million people are harmed each year by medication errors.

While no one profession is to " blame " for these errors the solution will be

found in improving the culture of safety in medicine. According to the Lucian

Leape Institute:

" ...achieving safety in the work environment requires much more than

implementing new rules and procedures. It requires the development and

sustainment of cultures of safety that engender trust and embrace reporting,

transparency and disciplined practices. "

http://www.npsf.org/download/LLI-Unmet-Needs-Report.pdf

As an example, the standard primary care treatment for dizzy patients is

anti-vestibular meds such as Meclizine or Antivert. Potential adverse reactions

to these meds are drowsiness and blurred vision which, paradoxically, increases

your patient's risk for falls.

This example may not be the standard vignette of potentially adverse drug

reactions but it is one where physical therapists can intervene to reduce future

risks by recommending to the physician to discontinue routine, long-term or

habitual use of anti-vestibular meds to treat dizziness.

Physical therapists can, in my opinion, impact medication lists primarily by

getting patients OFF their meds - not by prescribing more meds.

To do so we need to understand what is on these lists, we need to check these

lists and we need to make recommendations, when appropriate, to make these lists

shorter.

Thank you,

Tim , PT

www.PhysicalTherapyDiagnosis.com

> >

> > This is a question for those of you who manage hospital practices.

> First a bit of background: Several years ago during a Joint Commission

> survey, we were directed to obtain a medication list from each

> outpatient, and to check the list's validity at each subsequent visit.

> (With additional documentation to prove we've done so, of course.) I

> can find nothing in the CMS regulations, state practice, professional

> standards, or other regulatory bodies that require this in ambulatory

> settings.

> >

> > So here's the question: Are any of you doing this, and if so, why?

> Does anybody know of a regulation or standard that I might have missed

> that does require this in hospital outpatient settings? Conversely, can

> anybody state definitively that this is not required?

> >

> > Bob Perlson

> > Director, Rehabilitation Services

> > Rogue Valley Medical Center

> > Medford, OR

> > bperlson@

> >

> > http://bpsrehabblog.blogspot.com/

> >

>

>

> ----------------------------------------------------------------------

> NOTE: The information contained in this message may be privileged and

confidential and protected from disclosure. If the reader of this message is not

the intended recipient, or an employee or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify us

immediately by replying to the message and deleting it from your computer.

>

> E-mail has the potential to have been altered or corrupted due to transmission

or conversion. It may not be appropriate to rely upon this E-mail in the same

manner as hardcopy materials bearing the author's original signature or seal.

Thank you. Asante® Health System

>

>

>

[Guest guest]

Hi Bob,

Sorry to veer off your main point here but I'll have to respectfully disagree

with your statement that checking, updating and maintaining a medication list

adds " nothing " to patient safety.

500 people per day die in American healthcare due to preventable adverse

incidents and 1.5 million people are harmed each year by medication errors.

While no one profession is to " blame " for these errors the solution will be

found in improving the culture of safety in medicine. According to the Lucian

Leape Institute:

" ...achieving safety in the work environment requires much more than

implementing new rules and procedures. It requires the development and

sustainment of cultures of safety that engender trust and embrace reporting,

transparency and disciplined practices. "

http://www.npsf.org/download/LLI-Unmet-Needs-Report.pdf

As an example, the standard primary care treatment for dizzy patients is

anti-vestibular meds such as Meclizine or Antivert. Potential adverse reactions

to these meds are drowsiness and blurred vision which, paradoxically, increases

your patient's risk for falls.

This example may not be the standard vignette of potentially adverse drug

reactions but it is one where physical therapists can intervene to reduce future

risks by recommending to the physician to discontinue routine, long-term or

habitual use of anti-vestibular meds to treat dizziness.

Physical therapists can, in my opinion, impact medication lists primarily by

getting patients OFF their meds - not by prescribing more meds.

To do so we need to understand what is on these lists, we need to check these

lists and we need to make recommendations, when appropriate, to make these lists

shorter.

Thank you,

Tim , PT

www.PhysicalTherapyDiagnosis.com

> >

> > This is a question for those of you who manage hospital practices.

> First a bit of background: Several years ago during a Joint Commission

> survey, we were directed to obtain a medication list from each

> outpatient, and to check the list's validity at each subsequent visit.

> (With additional documentation to prove we've done so, of course.) I

> can find nothing in the CMS regulations, state practice, professional

> standards, or other regulatory bodies that require this in ambulatory

> settings.

> >

> > So here's the question: Are any of you doing this, and if so, why?

> Does anybody know of a regulation or standard that I might have missed

> that does require this in hospital outpatient settings? Conversely, can

> anybody state definitively that this is not required?

> >

> > Bob Perlson

> > Director, Rehabilitation Services

> > Rogue Valley Medical Center

> > Medford, OR

> > bperlson@

> >

> > http://bpsrehabblog.blogspot.com/

> >

>

>

> ----------------------------------------------------------------------

> NOTE: The information contained in this message may be privileged and

confidential and protected from disclosure. If the reader of this message is not

the intended recipient, or an employee or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify us

immediately by replying to the message and deleting it from your computer.

>

> E-mail has the potential to have been altered or corrupted due to transmission

or conversion. It may not be appropriate to rely upon this E-mail in the same

manner as hardcopy materials bearing the author's original signature or seal.

Thank you. Asante® Health System

>

>

>

[Guest guest]

Hi Bob,

Sorry to veer off your main point here but I'll have to respectfully disagree

with your statement that checking, updating and maintaining a medication list

adds " nothing " to patient safety.

500 people per day die in American healthcare due to preventable adverse

incidents and 1.5 million people are harmed each year by medication errors.

While no one profession is to " blame " for these errors the solution will be

found in improving the culture of safety in medicine. According to the Lucian

Leape Institute:

" ...achieving safety in the work environment requires much more than

implementing new rules and procedures. It requires the development and

sustainment of cultures of safety that engender trust and embrace reporting,

transparency and disciplined practices. "

http://www.npsf.org/download/LLI-Unmet-Needs-Report.pdf

As an example, the standard primary care treatment for dizzy patients is

anti-vestibular meds such as Meclizine or Antivert. Potential adverse reactions

to these meds are drowsiness and blurred vision which, paradoxically, increases

your patient's risk for falls.

This example may not be the standard vignette of potentially adverse drug

reactions but it is one where physical therapists can intervene to reduce future

risks by recommending to the physician to discontinue routine, long-term or

habitual use of anti-vestibular meds to treat dizziness.

Physical therapists can, in my opinion, impact medication lists primarily by

getting patients OFF their meds - not by prescribing more meds.

To do so we need to understand what is on these lists, we need to check these

lists and we need to make recommendations, when appropriate, to make these lists

shorter.

Thank you,

Tim , PT

www.PhysicalTherapyDiagnosis.com

> >

> > This is a question for those of you who manage hospital practices.

> First a bit of background: Several years ago during a Joint Commission

> survey, we were directed to obtain a medication list from each

> outpatient, and to check the list's validity at each subsequent visit.

> (With additional documentation to prove we've done so, of course.) I

> can find nothing in the CMS regulations, state practice, professional

> standards, or other regulatory bodies that require this in ambulatory

> settings.

> >

> > So here's the question: Are any of you doing this, and if so, why?

> Does anybody know of a regulation or standard that I might have missed

> that does require this in hospital outpatient settings? Conversely, can

> anybody state definitively that this is not required?

> >

> > Bob Perlson

> > Director, Rehabilitation Services

> > Rogue Valley Medical Center

> > Medford, OR

> > bperlson@

> >

> > http://bpsrehabblog.blogspot.com/

> >

>

>

> ----------------------------------------------------------------------

> NOTE: The information contained in this message may be privileged and

confidential and protected from disclosure. If the reader of this message is not

the intended recipient, or an employee or agent responsible for delivering this

message to the intended recipient, you are hereby notified that any

dissemination, distribution or copying of this communication is strictly

prohibited. If you have received this communication in error, please notify us

immediately by replying to the message and deleting it from your computer.

>

> E-mail has the potential to have been altered or corrupted due to transmission

or conversion. It may not be appropriate to rely upon this E-mail in the same

manner as hardcopy materials bearing the author's original signature or seal.

Thank you. Asante® Health System

>

>

>