The Real Nurse Jackie

Medication reconciliation — How would Dr. Seuss do it?

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Have you ever read Dr. Seuss's “Pill Drill” from “You're Only Old Once”? Wow, it's obvious he must have experienced our fragmented health system, where older adults see multiple specialists who never speak with each other and overwhelm a patient with medications they can't keep up with. 

Here's a section of it:

“This small white pill is what I munch at breakfast and right after lunch.

I take the pill that's kelly green before each meal and in between.

These loganberry-colored pills I take for early morning chills.

I take the pill with zebra stripes to cure my early evening gripes.

These orange-tinted ones, of course, I take to cure my charley horse.

I take three blues at half past eight to slow my exhalation rate.

On alternate nights at nine p.m. I swallow pinkies. Four of them.

The reds, which make my eyebrows strong, I eat like popcorn all day long.

The speckled browns are what I keep beside my bed to help me sleep.

This long flat one is what I take if I should die before I wake."

Wow, can you just imagine if this poor guy gets transitioned from the hospital and we have to reconcile all of those medications?  Oh wait, we do that every day.

We ask what medications they were on at home and we get “a little white one for blood pressure and a yellow one to make me pee, and a square blue one for my heart, and a little orange one for something or another and …”

And of course, the medication reconciliation we received from the 12-year-old surgical resident (OK, they all look 12 years old to me now) who assisted on the hip repair who dictated the transfer summary. He's listed every medication he saw listed in the medical record and history report so I have five different beta blockers listed for my new resident — and he only knows the colors of what he took at home.

Really, this is what someone thinks is medication reconciliation?! So 'Dr. X' in the nursing home, who has never, ever met this new resident, is supposed to figure this out? And we wonder why we spend $17 billion a year on readmissions among Medicare beneficiaries. 

Let's get real, guys. The solution isn't to keep taking money OUT of the system but to spend wiser so that we spend less in the end. There are studies that show that when a pharmacist does the med reconciliation, there are many, many fewer errors on transition. So pay for that and I bet you dollars to donuts that you save a few billion right there! (Can I have an “Amen!” please?)

So in this new year, we're gonna' get real about how we can fix this — if there is money to pay for it, which will save that $17 billion. (Oh, and save lives too if anyone cares!)

OK, climbing down off the soapbox for now.

Keeping it real,

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet. 

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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse who also is the director of clinical affairs for AMDA - The Society for Post-Acute and Long-Term Care Medicine. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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