Medication Reconciliation Case Study
A. Describe the complete process of medication reconciliation at your practice site including who is involved, what patient data is collected, how the data is collected and documented, and any other key steps in the process.
Upon admission, a medication history is obtained by an RN. If the patient is unable to provide the history at that time it can be done a number of ways: family interview, written patient med list, rx vials, recent H&P, transfer records, recent discharge med list, and/or retail pharmacy list. The pharmacist uses a program on the computer to pull up this gathered information to evaluate it for completeness and may interview the patient themselves. There is only one pharmacist responsible for med-rec therefore many patient
profiles have only the RN notes which are often not thorough. If a patient is being transferred, a medication reconciliation/transfer order (IVAR) is printed out and physically sent to the pharmacy for review if it is a transfer within the facility. If the transfer is to another facility the IVAR is forwarded to them. Patients receive a discharge medication list at the time of discharge which shows what medications are to be continued (done by RN or RPh).
B. Explain why medication reconciliation is performed at various times throughout the patient’s stay and name two times when medication reconciliation is performed at your site.
Besides admission, medication reconciliation is also done during transfers or discharges. The purpose of these medication reconciliations is to ensure patient safety and continuity of care. It is important to make sure that the patient receives their maintenance medications if they will be admitted to the hospital. If they transfer, the next facility needs to know their allergies and what medications the previous facility have already administered. Finally, discharge med-rec is necessary patient education on what medication changes have happened during their stay and why.
C. Discuss how pharmacists can impact the medication reconciliation process.
Pharmacists are more knowledgeable in the area of medication therefore they are more likely to ask the right questions and provide a more thorough medication list. They are able to notice discrepancies in lists given by patients and seek further clarification. The pharmacist at my site often double checks insulin orders at the hospital against what the patient was receiving at home to make sure it is equivalent to how much the patient is actually taking, not just what was filled at the pharmacy.
Upon admission, a medication history is obtained by an RN. If the patient is unable to provide the history at that time it can be done a number of ways: family interview, written patient med list, rx vials, recent H&P, transfer records, recent discharge med list, and/or retail pharmacy list. The pharmacist uses a program on the computer to pull up this gathered information to evaluate it for completeness and may interview the patient themselves. There is only one pharmacist responsible for med-rec therefore many patient
profiles have only the RN notes which are often not thorough. If a patient is being transferred, a medication reconciliation/transfer order (IVAR) is printed out and physically sent to the pharmacy for review if it is a transfer within the facility. If the transfer is to another facility the IVAR is forwarded to them. Patients receive a discharge medication list at the time of discharge which shows what medications are to be continued (done by RN or RPh).
B. Explain why medication reconciliation is performed at various times throughout the patient’s stay and name two times when medication reconciliation is performed at your site.
Besides admission, medication reconciliation is also done during transfers or discharges. The purpose of these medication reconciliations is to ensure patient safety and continuity of care. It is important to make sure that the patient receives their maintenance medications if they will be admitted to the hospital. If they transfer, the next facility needs to know their allergies and what medications the previous facility have already administered. Finally, discharge med-rec is necessary patient education on what medication changes have happened during their stay and why.
C. Discuss how pharmacists can impact the medication reconciliation process.
Pharmacists are more knowledgeable in the area of medication therefore they are more likely to ask the right questions and provide a more thorough medication list. They are able to notice discrepancies in lists given by patients and seek further clarification. The pharmacist at my site often double checks insulin orders at the hospital against what the patient was receiving at home to make sure it is equivalent to how much the patient is actually taking, not just what was filled at the pharmacy.