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Medication Reconciliation and MedsCheck Initiative with Community Pharmacists Alice Hogg, RPh Shellyna Moledina, RPh Patricia Brown, RPh May 6, 2008 © Institute for Safe Medication Practices Canada 2007® Medication Reconciliation What Is It? • A process where medications are compared at interfaces of care • Discrepancies are identified and reconciled with the physician • Intervention minimizes patient harm from unintended discrepancies © Institute for Safe Medication Practices Canada 2007® Best Possible Medication History BPMH is a list of what the patient is actually taking (not necessarily just what was prescribed) • Gathered by using more than 1 source of information (e.g. MedsCheck, patient interview, medication vials, Drug Profile Viewer, medication profile, community pharmacist, family physician) • identify and resolve discrepancies between what was ordered and what the patient is actually taking • contact the physician to resolve discrepancies © Institute for Safe Medication Practices Canada 2007® Why is the BPMH useful? • Helps to ensure home medications are continued in hospital if appropriate • Helps to resolves discrepancies between what was ordered and what the patient was actually taking prior to admission • Ensures continuity of care © Institute for Safe Medication Practices Canada 2007® 2008 ISMP Canada MedRec/MedsCheck Hospital Project • 10 hospital sites • Pre-admission surgical clinic - elective patients • Asking patients for a MedsCheck to be done prior to admission to the hospital • RN gathers Best Possible Medication History at preadmission clinic • Using MedsCheck as the primary source of information • Measure the value and impact of the MedsCheck program to MedRec in hospital © Institute for Safe Medication Practices Canada 2007® MedsCheck Ministry of Health and Long-Term Care © Institute for Safe Medication Practices Canada 2007® Community Pharmacist’s Role • Accommodate patient’s requests for MedsCheck or Follow-Up prior to their preadmission clinic appointment. (1-2 weeks) • Record all the medications the patient is actually taking even if it differs from the prescribed instructions. • The profile should include all current prescription and over-the-counter medications. © Institute for Safe Medication Practices Canada 2007® What is the effect on Patient Care? • Develops and strengthens the relationship between patients and their community pharmacist. • Improves seamless care between the community and hospital to ensure patients receive medications correctly and appropriately between transfers of care. • Prevents medication errors and improves the efficiency and accuracy of the medication ordering process in hospital. • Impacts the entire continuum of care © Institute for Safe Medication Practices Canada 2007® Linking MedsCheck to Medication Reconciliation Coordinating MedsCheck and medication reconciliation in Ontario will contribute to the seamless transfer of accurate information and contribute to the improvement of patient care and safety. © Institute for Safe Medication Practices Canada 2007®