Download Proactive/Prospective vs. Retroactive

Proactive/Prospective vs. Retroactive/Retrospective BPMH
PROACTIVE/PROSPECTIVE Model
Ideally, the admission BPMH is created prior to medications being ordered. In a
proactive/prospective model, the medication orders are based on the information provided on
the admission BPMH to ensure that all of the medications have been assessed and any changes
have been documented and communicated.
The steps include:
Complete
Admission BPMH
(Using at least 2 sources of
information, including the
patient/resident interview when
possible)
Reconcile
Prescriber creates Admission
Medication Orders
(Using admission BPMH as
reference)
During the reconciliation step, compare the admission BPMH against the admission medication
orders to:
 ensure all of the medication on the admission BPMH have been considered and any
changes have been documented to ensure clear communication
 identify and resolve all discrepancies with the prescriber
Note: The proactive/prospective model is usually used at sites/units where there are fewer
admissions or where the admission process is structured.
Covenant Health | Proactive/Prospective vs. Retroactive/Retrospective BPMH
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RETROACTIVE/RETROSPECTIVE Model
At times, there are influencing factors that might prevent the completion of an admission
BPMH prior to the admission medication orders being determined (i.e. patient trauma). As
such, the retroactive/retrospective model is used.
In the retroactive/retrospective model, the admission medication orders are created based on a
preliminary medication history as opposed to the BPMH (as seen in the proactive model). The
BPMH is completed in a timely manner (within 24 hours) and reconciled with the admission
medication orders.
The steps include:
Create Preliminary
Medication History
(Initial medication
history)
Prescriber creates Admission
Medication Orders
(Using preliminary medication
history)
Complete
Admission BPMH
(Use at least 2 sources of
information, including the
patient/resident interview if possible
Reconcile
Prescriber reviews,
identifies and
resolves any
discrepancies
(If applicable)
During the reconciliation step, compare the admission BPMH against the admission medication
orders to:
 ensure all of the medication on the BPMH have been considered and any changes have
been documented to ensure clear communication
 identify and resolve all discrepancies with the prescriber
Note: The retroactive/retrospective model is usually used at sites/units where there are high
admission volumes and patient/resident requires immediate treatment.
Covenant Health | Proactive/Prospective vs. Retroactive/Retrospective BPMH
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