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 patient’s “home medications” must be implemented and in place January 2006 This is a Regulatory Requirement Based on recorded sentinel events

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

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

5. 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” Preventing Errors

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 orders—already 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. Physician’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

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