Medication Reconciliation and Scope of Practice

Recently I have been receiving a number of questions about whether the process of medication reconciliation falls within medical assistants’ scope of practice. This is an important issue worthy of discussion. The following is my position on the issue:

The Joint Commission defines medication reconciliation as follows:

The process of comparing a patient’s medication orders to all of the medications that the patient has been taking.  This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care.  This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.

It is my legal opinion that knowledgeable and competent medical assistants can be assigned steps 1 and 2 as long as step 2 entails compiling a list of prescribed medications from the prescription orders of providers. However, steps 3 and 4 require the exercising of independent professional judgment and the making of clinical assessments. Therefore, in my judgment, medical assistants cannot be assigned 3 and 4. In regard to step 5, medical assistants can communicate verbatim new lists of medications as specifically approved by the overseeing/delegating provider, and only when the provider directs the medical assistant to do so.

 

About Donald A. Balasa

Donald A. Balasa, JD, MBA, chief executive officer and legal counsel for the American Association of Medical Assistants, keeps his eye on what is happening in the profession.
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4 Responses to Medication Reconciliation and Scope of Practice

  1. Jessica says:

    You don’t think we are capable of looking at two different lists and comparing them to note the discrepancies? We can’t edit lists to remove duplicate entries -such as when a patient has a generic and the name brand of the same medication both listed? I’m actually quite offended. Medical assistants are bright and intelligent individuals, and many of us have gone to school for this profession. There are also quite a few of us working and going to school to nursing school.

  2. Kathleen Fisk says:

    I totally agree that this will further narrow our scope of practice and affect many of our jobs. I compare lists all the time and have for almost 40 years. We can’t keep having duties taken away or they will be no need for a CMA in a clinic setting.

  3. Kathleen Fisk says:

    I totally agree that this will further narrow our scope of practice and affect many of our jobs. I compare lists all the time and have for almost 40 years. We can’t keep having duties and procedures that are part of the rooming process taken away or there will be no need for CMA ‘s in a clinic setting.

  4. celeste barlow says:

    I am in total agreement with the other responders. I have been doing this for 35 years. My clinical judgement , assessment of situations has never been faulted. Although most of our CMA’s are more educated than LPN’s, we are being replaced because they are licensed. I believe the only option to help us is to license CMA’s. Our hospital has joined forces with a community college which certifies MA’s after 12 weeks. We are all lumped together w/o a distinction. The MA’s are half the price of an LPN.
    Please help! There are several CMA’s in my office who are fearing loss of their jobs. We are at the highest end of the pay scale and the can hire these new MA’s for far less. The LPN’s are being hired for what the seasoned MA’s do and we have to train them.
    Please let me know if there is anything we can do.
    Otherwise, I feel that becoming a CMA is not a good choice when you can become an LPN and get much more respect and better salary.
    Thank you.
    I have hope that the CMA can be saved and recognized as competent health care workers.
    Celeste Barlow CMA (AAMA)

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