Happy says patients need to own it, but they won't.
Early in my blogging career, naïve about the law of unintended consequences, I thought Joint Commission's med rec initiative was a great idea. Turns out it hasn't worked. When it comes to medication safety across transitions of care we're no better off, maybe even worse off, than before the initiative.
Decades ago docs had their own simple version of med rec. Admission orders might read “give home meds, home dosage, home schedule except D/C digoxin.” Discharge orders might read “home meds same as pre-admission except change digoxin to every other day, increase lasix to bid, increase Ktabs to bid.” I remember one time as a resident discharging a patient from the “private” service. I asked the attending what to order in the way of discharge medications. He said “just tell the patient to take his bottles to his druggist and have the druggist call me.” And you know what? It wasn't perfect but it worked. One reason it worked as well as it did was that the patient did have to own it, along with the nursing staff. But through the years, every so often someone would get the bright idea to turn it into a “process,” which usually meant a new form or a new template. And with each new process, and its accompanying forms or templates, came another opportunity to mess stuff up. With Joint Commission's med rec process the paper form and the electronic template became a substitute for someone sitting down with the patient and really addressing the details.