Medication Reconciliation

1
Medication Reconciliation
JCAHO Patient safety Goal 8
2
Mandate

• To improve patient safety and provide
  consistent care, a medication reconciliation
  process incorporating a patients home
  medications must be implemented and in place
  January 2006
• This is a Regulatory Requirement
• Based on recorded sentinel events

3
Definition

• A formal process of identifying the most accurate
  list of all medications a patient is taking, and
  using this list to provide correct medications
  for patients anywhere within the health care
  system
• Requires comparing the patients list of current
  medications (home meds) against the physicians
  admission, transfer, and discharge orders

4

• IHI
• One of the six proven interventions to save
  lives
• Prevent Adverse Drug Events (ADEs)
• by implementing medication reconciliation

5
Preventing Errors

• Inadvertent omission of needed home medications
• Failure to restart home medications
• Duplicate therapy (the result of brand/generic
  combinations or formulary substitutions)
• Orders with incorrect doses or dosage forms
• Physician orders include meds as at home

6
Approved by Med. Exec.

• Attending physician must be responsible for
  medication reconciliation at time of admission,
  transfer and discharge
  One - Captain of the Ship
• Eliminate all physician order such as
• Resume home meds
• Resume pre-procedure orders
• Resume pre-op ordersalready approved by MEC
• Surgeon will review post op and intensivist may
  review on transfer to ICU

7
When Medication Reconciliation is Required

• Admission Screen review and formal
  acknowledgement
• OR DC/Cancel function and formal
  acknowledgement (approved by MEC)
• ICU Screen review and formal communication
  (approved by MEC)
• Discharge Paper form (similar to the 3008 form
  currently in use for ECF)

8
Physicians Role

• Review home meds list at the time of admission,
  transfer, or discharge
• Enter a reconciliation communication in SCM
  acknowledging that the patients home medication
  list has been reviewed on admission and transfer
• Complete Medication Reconciliation Report from
  SCM at discharge with list of home and active
  pharmacy orders indicating continue or
  discontinue at home
• The Attending physician is ultimately
  responsible for medication reconciliation the
  Captain of the Ship
• It is the responsibility of the Attending
  physician to communicate with consulting
  physicians to clarify medication orders

9
Choose Medication Reconciliation from the
Clinical Summary Tab
10
Choose Medication Reconciliation Communication
11

A mandatory field must be completed.
12
When the attending physician logs onto the
chart, an alert will be triggered interrupting
the order session if a reconciliation
communication has not been placed in the chart
13
This is the alert to direct the attending to
use the View Actions
14
The attending should click on keep this order
(indicating the Chem 7 in the example).
15
Next, the attending should click on Actions
16
The Medication Reconciliation Communication Order
field will be visible and mandatory.
17
Once the attestation is complete, the attending
physician should click OK
18
The order entry window will appear and orders
can be submitted as usual.
19
This form is printed on discharge. From the
orders tab in SCM, click on the printer icon and
choose Medication Reconciliation Report
Attending will indicate which medications are
to be continued or discontinued by checking in
the appropriate column
20
Bottom half of Reconciliation Form
Nursing will use this list to complete the
patient discharge Instruction form completing the
reconciliation process