medication reconciliation education
TRANSCRIPT
Medication
Reconciliation
Education
April 2013
Medication Reconciliation
Education
Purpose: We can improve patient safety and care outcomes by performing medication reconciliation
Everyone plays a role in Medication Reconciliation
Our medication reconciliation policy has been simplified
Audits have shown that Medication Reconciliation done by nurses are sometimes incomplete
This is your education about the new policy changes
Medication ReconciliationOur policy is organized in 3 ways:
1. Patient Status
• ED vs. Inpatient/Observation
2. The action occurring with the patient
a) Admission
b) Transfer
c) Discharge
3. Role of person engaged in Med Reconciliation
a) Nursing responsibilities
b) Pharmacy responsibilities
c) Prescriber responsibilities
Note: For this education, we are focused on Nursing responsibilities only
Medication Reconciliation
When do we need to reconcile medications?
Admission
Transfer
Discharge
Medication Reconciliation
Exceptions to completing the regular process:
ED: review names only
Cardiac Cath/EP lab: med report from field
Interventional radiology: provide pharmacy list of
meds, allergies and contrast medication orders
Daycare patients for procedures (with no med adjustment):
med names and allergies
Peds sedation: Med names and allergies
Dialysis – dialysis meds are not included on home
med list
Medication Reconciliation
Review names of meds only
Record dates and times of last doses for antibiotics and b-blockers
Record any other med information related to care in the ED in the text box for last dose
If there is a med that has been completed you may remove by using the red X
In the text box for Last dose: Type “Y” if pt is taking the medications
Type “N” if pt is not taking the medications
When review is complete fill in status box
Mark as reviewed
ED (preadmission)
“y” or “n” in this
text box
Select one of these 3
options
Beta-blocker or Antibiotic here Date and time here
Medication Reconciliation Admission – Nurse responsibilities
Goal: Obtain medication history to create an accurate home med list
Exceptions for starting this process…
1. Certain patient populations: SNF and CBRF patients- give a copy of MAR to pharmacy SPC – pharmacy interviews surgicals and medical EMAs, RN interviews the
other medical patients ER only verified names of meds, admitting RN needs to complete
2. Pharmacy has already completed the med history or reconciliation (see next slide)
If pharmacy has chosen a
status before you begin…
call the pharmacist prior to
changing the list or the
status box
Reviewing Medications Information to include with each med:
Name
Dose
Dose form
Route
Frequency
Date/time
of last dose - am/pm is ok most of the time Beta blockers, Antibiotics need specific time
Ask about OTCs, herbals, eye drops, nasal sprays
etc
Metoprolol
25 mg
Tablet
By mouth
Daily
2/28/13 0800
Multivitamin
One
Tablet
By mouth
daily
2/28/13 am
Adding MedicationsAdd the missing medication, include the same elements as in the
review and document date and time of last dose
Add all
medication
information
Add date and time of last dose
Removing Medications
Remove meds that the patient is appropriately not
taking by using the red X and selecting “remove
from PTA list”
examples: completed antibiotics
completed surgical prep
MD instructed pt to d/c use
Duplicate entries of the same med
Changing Medications
if patient is taking med differently
than listed but according to MD instruction
remove med entry using red X
add med as above
Unclear Entries If it is unclear if the medication should be removed from
the list or changed, just type the information into the last dose field for the pharmacist to review.
When might this happen? Non-compliant patient
Patient changed dose or frequency without MD knowledge
Patient misunderstood directions and has been taking incorrectly
Pt stopped med for financial reasons
Patient can only provide a portion of the information
Please use last dose field for
communication…not the paper icon
Happy
Pharmacist
Unhappy
Pharmacist
Writing in the paper icon stays
in the chart forever so just
pretend it isn’t even there!
Inpatient RN
Medication Reconciliation
Transfer of patient – Nurse responsibilities
Release orders at the time of pt physically transferring
to the new unit
If pt unable to be physically transferred, release and
act on the orders – the orders are considered a level
of care change regardless of physical location
Medication Reconciliation
Discharge – Nurse responsibilities
Review the orders and check the status of
d/c orders in shopping cart
Provide patient necessary discharge
documentation, medication education
and d/c instructions
d/c to another provider: print facility
transfer order report (2 copies – one for
facility and one for SMH chart)
Facility Transfer Orders – for discharge