I remember working on a skilled Medicare unit and dreading the end of each month when that stack of new MARs were delivered from the pharmacy. I remember it very clearly, no one made eye contact with each other for fear it would be your turn to reconcile the month-end medication and treatment orders. It was definitely a tedious process and management assigned specific nurses to perform the “task”, they were actually paid overtime to come in and hide in a conference room to reconcile the medications.
Now with eMAR and EHR systems, it is a totally different process and some studies have shown that it is not as effective as the hands-on, paper MAR review. Yes, there are studies out there where scientific evaluation processes are used to determine the “why” we continue to struggle with medication reconciliation. Do we need studies like these? Absolutely, there is always a kernel of truth in every study outcome. Is it time to go back to basics? Maybe!
Maybe, just maybe, there is more to the problem that doesn’t require a scientific study? Way back in the dark ages, I knew every single resident, their needs, their medications, their family, etc. Nurses were terminated for passing “meds by memory” because they thought they knew the resident that well but might have missed a new order. Medication reconciliation wasn’t taken lightly, it was a function that needed qualified staff to do. At the end of the day, it was also familiarity, consistent assignment, we knew when something wasn’t “right” because we cared for that resident daily.
We are all awakening to a new world, post-COVID. These are the kind of things we need to be focusing on. There is no replacement for consistent assignments, seriously. Residents appreciate the familiar faces, staff appreciate knowing where they will be assigned ahead of time and yes, there are studies that show that consistent assignment does alleviate a lot of stress, medical errors and improves resident satisfaction. In the meantime, take a look at your current process for medication reconciliation, review the study linked, take the information to your QAPI committee and see if you can’t do better! Stay well, stay informed, and stay tuned!