In the past, a significant aspect of medical education has been what we have learned from discussions with our colleagues. However, in the present regulatory atmosphere, the issue of patient privacy has escalated.

You need to know the precautions you and your staff must take in order to avoid personal liability.

Plan to attend the Grand Rounds on:

Friday, April 17
12:30 pm
Hospital Auditorium

Reconciliation of medications for discharge to home (ROMACC National Patient Safety Goal #8) is a two - step process.

Review the Home Medication list for medications to take or stop at home

AND

reference the inpatient MAR (Clinicomp MD Med EPO Summary or the Carecast Active Medication Summary) to ensure any new medication initiated in the hospital is addressed at discharge.

If new prescriptions are required please ensure all prescriptions are documented on the Discharge Home Medication List.

Reconciliation of medications for interfacility transfers is a two-step process.

Review the inpatient MAR (Carecast Active Medication Summary) for medications to continue or dc upon transfer

AND

reference the patient's home medication list to ensure all medications are addressed and reconciled upon transfer. This ensures that a patient's previous medications, either from home or from a facility that are not continued during the inpatient admission can be restarted at the facility.

A more detailed summary from the Joint Commission follows.

Two lists must be maintained during the hospitalization. The "home medications" list should be maintained unchanged and available for subsequent use in the reconciliation process. The list of the patient's current medications while in the hospital is a dynamic document that will require updating whenever changes are made to the patient's medication regimen. Whenever reconciliation is carried out, both lists should be considered. The reason for referring back to the "home" medication list is that some "home" medications may be held when a patient is admitted or goes to surgery. They may need to be resumed upon transfer to a different level of care, return from the OR, or at discharge.

The discharge medication list is not an "order" for medications; it is just a summary list of everything the patient/client/resident will be taking-similar to the home medication list that was gathered at the time of admission. It should be treated in the same way as other discharge instructions.

The discharge medication list is a complete list of the medications that the patient/client/resident is to be taking following discharge and it should be reconciled against both the current inpatient list and the home medication list. The discharge medication list should include not only the medications that are prescribed at the time of discharge, but any other medications the patient/client/resident will be taking, including over-the- counter meds, vitamins, etc. The purpose of this discharge reconciliation is to provide the patient with a single, clear list of all the medications that the patient is to be taking following discharge. This requires that all medications are identified, including any medications the patient/client/resident might have been taking at home that were discontinued or "held" during the episode of care. It should also determine whether any of the previous home medications should be discontinued. It is also reasonable to interview the patient to determine if he or she plans to resume taking any OTC or herbal medication after discharge. The complete, reconciled discharge medication list should then be used as a basis for the required patient/client/resident education on the safe and effective use of those medications.

Questions regarding ROMACC may be directed to Julie McCoy, SGH Safety Officer, at 619-740-4663.

Physicians are encouraged to participate in the voluntary and anonymous reporting of actual or potential events and may do so in one of two ways:

· Via the Sharp Intranet - Go to "E" for eQVR or "Q" for QVR and follow the instructions for submitting an eQVR for "All Users"; this allows anyone to enter an incident anonymously. Be sure to select the correct facility, type of incident (inpatient/outpatient/emergency patient for example). Avoid using "other" if possible. Enter the patient's 8-digit account no. and hit "look-up" to auto import all patient data for you. Click "continue" to go to P.2 to complete the details of your incident.

· Physicians may also DICTATE a Confidential QVR (that goes directly to the QA Office). Using the physician dictation line, select code #45 (for Confidential QVR) and dictate as usual (please be sure to include patient information).

Physicians may view a training CBL (that gives a more detailed step by step explanation of the QVR entry process) available on the Sharp Intranet. Go to "E" for eQVR or "Q" for QVR. In the right column, select "eQVR Training". Go to the bottom of the training page and select the "Anonymous Reporter Review" CBL.

IMPORTANT: Medical staff members and hospital staff should never document completion of an eQVR in the medical record. That documentation might allow the QVR (and peer review associated with the QVR) to become "discoverable" in court.

The electronic incident reporting system (eQVR) was implemented April 2006 at Sharp HealthCare in hopes of enhancing the Patient Safety environment by:

· Identifying events requiring action in order to prevent recurrence, and
· Identifying potential risk management events.

Sharp Healthcare promotes a non-punitive, anonymous reporting system of all potential ("near misses") and actual quality variance issues in order to:

· Identify systemwide issues,
· Identify trends (departmental or service line) issues, and
· Implement process changes where needed to avoid reoccurrence when the above issues are identified.

For questions or assistance regarding the eQVR process, please contact Grossmont Hospital's eQVR Administrator: Annette Guinther, RN QA at 619-740-4693

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