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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 1 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 2