Medication Reconciliation

“One of America’s Best Hospitals” – U.S. News & World Report

Medication ReconciliationMedication Reconciliation

JCAHO Patient safety

Goal #8

MandateMandate To improve patient safety and provide consistent

care, a medication reconciliation process incorporating a patient’s “home medications” must be implemented and in place January 2006

This is a Regulatory RequirementBased on recorded sentinel events


DefinitionDefinitionA 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 patient’s list of current medications (home meds) against the physician’s admission, transfer, and discharge orders


IHIOne of the six proven interventions to save lives:

Prevent Adverse Drug Events (ADEs)…by implementing medication reconciliation


Preventing ErrorsPreventing 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”

Approved by Med. Exec.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 orders—already approved by MEC

*Surgeon will review post op and intensivist may review on transfer to ICU

When Medication When Medication Reconciliation is RequiredReconciliation 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)

Physician’s RolePhysician’s Role• Review home meds list at the time of admission, transfer, or

discharge• Enter a reconciliation communication in SCM acknowledging

that the patient’s 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

Choose Medication Reconciliation from the Clinical Summary Tab

Choose “Medication Reconciliation

Communication”

*

A mandatory field must be completed.

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

This is the alert to direct

the “attending” to use the “View

Actions”

The “attending” should click on “keep this order” (indicating the

Chem 7 in the example).

Next, the “attending” should click on

“Actions”

The Medication Reconciliation Communication Order field will be

visible and mandatory.

Once the attestation is complete, the “attending” physician should

click OK

The order entry window will appear and orders can be submitted as usual.

“Attending” will indicate which medications are to be

continued or discontinued by checking in the appropriate

column

This form is printed on discharge. From the orders tab in SCM, click on the printer icon and choose Medication

Reconciliation Report

Nursing will use this list to complete the patient discharge Instruction

form completing the reconciliation process

Bottom half of Reconciliation Form

Medication Reconciliation

Documents

Transcript of Medication Reconciliation