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Medication Reconciliation MUSE 2006 Markham Stouffville Hospital Alice Watt, B.Sc.Pharm 2006 AIM Med Rec - What is it? The Journey Toolbox Admissions Transfers Discharge Reports Lessons Learned What is it? Medication Reconciliation Process of : 1. Getting the Best Possible Med History 2. Using the BPMH to write admission orders 3. Identifying and reconciling discrepancies with the physician Important for our patients because… Saves lives medication errors and adverse drug events. The Journey Implementation in ER, 3E, ICU Pilot project 2002 Getting Started Data collection 2003 Paper Record Electronic record 2004 2005 Hospital-wide implementation 2006 Toolbox Admissions Medication Profile– Paper Record Diagnosis/Surgical Procedure Unit/Rm Medical Conditions Physician Date of Admission Allergies Barriers Meds Meds Prior To Ordered on Admission Admission Please See Computer if Dosage ordered Med Hx no by MD Pharmacist to Do Warfarin Amino Phenytoin CADD Other: Computer Med Hx completed Ht ABW Social History From home From LTC/NH Other: NAME. (Place identification sticker here. ) IBW DBW Age M F Smoking Never Former Current Interventions Alcohol Sub No use stance Social Abuse New Meds Started or Changes in Regimen or Discontinued by MD Source of med info Patient Family Pharmacy GP Vials Community Pharmacy/ Phone Number Consent Discharge Date/Plan Obtained? Yes Process Interventions Medication History Patient Name Synthroid 0.1 mg PO daily Metformin 500mg PO TID Synthroid 0.1mg po daily Metformin 500mg po tidcc ECASA 81 mg po daily Medication Reconciliation Screen Patient Name Pre-set options Patient interview DPV Pill’s Pharmacy – (416) 333 - 9999 Synthroid 0.1mg PO DAILY N Metformin 500mg PO TIDCC Y Called MD EC ASA 81mgPO daily Y Not Necessary U D Order Changed Patient Assessment Patient Name Counsel patient at discharge concerning new BP meds Speaks no english – Family to be present to help translate Visual FlowSheet - Reconciliation Pre-op Medication Report Medication Reconciliation Record and Doctor’s order Transfers Transfers Medication orders are compared by physician at transfer points. ICU Medicine Surgery/Short Stay Rehab Transfer Order Sheet Warfarin Monitoring Warfarin Monitoring - VFS Discharge Discharge Admission Medication reconciliation helps at discharge Work in progress PDRx Discharge Medication List DOCTOR: LOCATION: PATIENT: Reports Reports Monthly report for Safer Healthcare now Run by date Categories include : Type of variances # of medications reconciled # of patients reconciled by ID number Time to reconcile vs. time of admission Time to reconcile each patient Lessons Learned… Trial and Error Task Force It’s a Team effort Questions