Medication Reconciliation Inpatient Process: Admission OriginAmbulatory Surgery or Procedural Area

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Medication Reconciliation Inpatient Process
Admission OriginAmbulatory Surgery or
Procedural Area

• Ambulatory Surgery or Procedural Area Nurse
  documents home medications in Med Profile Tab
  (single shared medication list) via
  pre-op/pre-procedural checklist

• Home meds listed in Med Profile tab are available
  for screening against medications to be
  administered during procedure/surgery

• Inpatient physician to place discharge order
  have reviewed patients home medication list in
  Med Profile Tab
• Physician to update Med Profile Tab and to insert
  medications into Discharge Summary and Discharge
  Instructions

• If applicable during patients hospital stay
  inpatient physician places transfer order
  have reviewed current medications and reconciled
  with patients home medication list in Med
  Profile Tab

• Post-operatively, inpatient physician confirms
  home medications and indicates plan for meds in
  Med Profile Tab via Power Form

• Nurse will complete Medication Reconciliation
  section of the Discharge Form and contact
  physician if Med Profile is not updated

• Nurse reconciles home medication list with
  patient and then with current orders (task drops
  at 4 hrs post admission) via Power Form

• Physician updates Medication list and it is
  communicated to next care provider (includes PCP)
  via email, voicemail, fax or paper document
• Medication list must also be given to patient
  upon discharge

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Process excludes patients seen and not admitted