Medication Reconciliation

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Medication Reconciliation
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Medication Reconciliation
What is it?
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Medication Reconciliation
Medication Reconciliation is a process of
documenting a complete and accurate list of the
patients pre-admission medications and then
comparing that list against the physicians
admission, transfer and/or discharge orders.
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Medication Reconciliation
Why do it?
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Why?
A patient was admitted for surgery. Her family
gave the nurses a list of medications she was
taking at home. Among the medications was
Methadone 5 mg orally. After surgery the
physician assistant faxed in an order from the
office to give 50 mg of Methadone to be given
orally BID.
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What happened?
The nurse and the pharmacy did not question the
order give 50 mg of Methadone to be given orally
BID. As a result The patient was given 50 mg
of Methadone BID she received two doses of 50
mg . Later the patient had a respiratory arrest
and was transferred to ICU.
Yes, It happened HERE at Riverside!
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So, Why do Medication Reconciliation?Choose one
of the following

• Because its important for the safety of your
  patient
• Because its the right thing to do
• Because its one of those dang Joint Commission
  things
• Because its all these things and so much more!

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2 out of every 100 patients admitted to the
hospital will experience a preventable
adverse drug event (ADE). 50 of all medication
errors and 20 of ADEs in the hospital are due
to poor communication handoffs. 80reduction
in potential ADEs within 3 months of
implementing Medication Reconciliation.
Still not convinced?
It's the Standard of Care
Michels RD, Meisel S. Am J Health-Sys Pharm
2003601982-1986
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Medication Reconciliation
What is the Process?
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Medication Reconciliation
Admission Transfer Discharge
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In the Emergency Department, Pre-Assessment
Center, Ambulatory Setting, or on the nursing
unit, the patients medication list is obtained

• The medication list may be obtained from
• the patient
• family members
• the primary care physicians office
• the patients pharmacy
• On line resources
• IBEX (Emergency Dept)
• Logician (Riverside Medical Group)
• Sorian Imaging

DO
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• Patients admitted from the Emergency Department
• Medication list obtained and entered into IBEX

• Medication List from IBEX is placed with the
  Physicians Orders
• As the Admitting Physician, an Admission Med Rec
  form can be printed from IBEX through Rx Concile.

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Use the Medication Reconciliation Form to write
admission orders by circling C for
medication to be continued DC for medications to
be discontinued N for new medication orders
Sign the form
The Admission Process
The Medication Reconciliation Form is then
scanned to the Pharmacy. The Medication
Reconciliation Form is an order form.
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Incomplete Orders Delay Treatment
Indication
Route
C
DC
Dose
Frequency
N
Medication
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The NEW and IMPROVED Medication Reconciliation
and Admission Order Form
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Initial Medication Reconciliation Form

MEDICATION HISTORY
RECORDED/VERIFIED BY _____________________
DATE RECORDED______
Use this form for OUTPATIENTS too!
For Outpatients, use it for Reconciliation at
Admission and Patient Instructions at Discharge
(not an order).
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Initial Medication Reconciliation Form

MEDICATION HISTORY
RECORDED/VERIFIED BY _____________________
DATE RECORDED______
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MEDICATION HISTORY RECORDED/VERIFIED BY
_____________________ DATE RECORDED______
Initial Medication Reconciliation Form Bottom of
the form
The physician must sign the completed form for
inpatients. The nurse signs at the bottom when
the order is signed off. For inpatients, this is
an order sheet scanned to Pharmacy.
The above medications have been reconciled to
determine if any items should be discontinued
because of contraindications or interactions with
treatment or new medications. Outpatients Medicat
ions reconciled at admission ____________________
_______________________________________Date/Time
Medications reconciled at discharge and
instructions provided to patient
_______________________________Date/Time Inpatien
ts ? Verbal/telephone order ___________________
______________________/________________________
Date/Time Physician Signature
__________________________________________________
_____________ Date/Time Nurse Signature
__________________________________________________
________________ Date/Time Inpatient Scan to
Pharmacy. File in Orders Section of the chart.
Outpatient Original-chart, copy-patient
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Initial Medication Reconciliation Form What if
the patient takes no medications?

MEDICATION HISTORY
RECORDED/VERIFIED BY _____________________
DATE RECORDED______
Check On no medications at home on the
Admission Form and sign. This documents the
patient was asked about home meds and it was not
overlooked.
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When the patient is transferred from one level of
care to another, a Transfer Medication
Reconciliation Form must be used
Transfer To another level of care
This form will be provided for you. If one is NOT
provided, ask the nurse or unit secretary to
print one for you. Remember it takes TEAM WORK
for patient SAFETY!
DO
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Transfers?
Operating
Emergency
Room
Department
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Change in Level of Care?
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Transfer Medication Reconciliation Form
Patient Name
This is an order form and will be scanned to
Pharmacy.
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Transfer Medication Reconciliation Form

• Transfer to the OR
• The Nurse or Unit Secretary will print a Transfer
  Medication Reconciliation Form
• It will be placed in the Orders section of the
  chart.
• A printed copy of the current MAR will be placed
  in the
• Medications section of the chart.
• The Surgeon will use the Reconciliation Form to
  write post-op medication orders.

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NEVER write Resume home meds or Continue
home meds
ON DISCHARGE
On discharge, the discharge medication
reconciliation form is used. The physician
reconciles the home/preadmission meds not
continued in the hospital (HOM) with home/pre
admission meds continued with current hospital
meds. Any additional meds are added
DO
Once reconciled this is the complete current
list of home meds
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Discharge Medication Reconciliation Form
C or DC
Verify and Sign
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Medication Reconciliation
Okay, okay JUST tell me what I have to do.....
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Medication Reconciliation

• Look for the appropriate Medication
  Reconciliation Form on the chart
• Ask the Nurse or Unit Secretary for assistance if
  its not provided
• Do NOT ask the nurse to complete your portion of
  the form,
• Circle C, DC or N for every medication
• Sign the form, remember it becomes an order form

ITS YOUR RESPONSIBILITY
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Medication Reconciliation
In your private practice Promote "A List for
Life"
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To obtain free Medicards for YOUR patients
contact Judy Bucher 594-2005
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LIST FOR LIFE
Medication Reconciliation
is the
BEST MEDICINE
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QUESTIONS?
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Call Riverside Pharmacy
Youlanda Logan 594-2620 or Cindy
Williams 594-3769