Medication Reconciliation Interviewing Tips - The importance of the different goals from admission to discharge in terms of medication reconciliation. - Be Proactive - Prompt questions about non-prescription - Usage of therapeutic communication during categories medication administration interviewing. - MEDICATION RECONCILIATION By Justin Ha and Yolanda Pina Don't assume patients take meds as prescribed - Without medication reconciliation, the rate of - Use open-ended questions medication errors will increase. - Use medical conditions as a prompt - Consider patient adherence with prescribed References regimens - Verify accuracy - Obtain community pharmacy contact information - Use BPMH trigger sheet (interview guide that includes summary of patient meds) - Assuring Medication Accuracy at Transitions in Care: Medication Reconciliation. 3rd Volume. The High 5s Project Standard Operating Protocol. Agency for Healthcare Research and Quality, USA, WHO, and the Commonwealth Fund, USA. 2014. - Chapter 5. education and training. AHRQ. (n.d.). Retrieved November 13, 2021, from https://www.ahrq.gov/patientsafety/resources/match/match5.html. - Stowasser D, Collins D, Stowasser M. A randomised controlled trial of medication liaison services - patient outcomes. J Pharm Pract Res 2002;32:133-40. Medication errors are very common and often occur when patients move between healthcare settings and providers. Around half of hospital medication errors occur on admission, transfer and discharge. Advanced age and taking several prescription medicines are associated with an increased risk of medication errors on admission. Medication reconciliation can significantly decrease errors. It involves obtaining, verifying and documenting a list of the patient’s current medicines and comparing this list to the medication orders and the patient’s condition to identify and resolve any discrepancies. Key Points ADMISSION The goal is to obtain the most accurate list of medications the patient was taking prior to admission to the facility. 2 types of model: The goal of medication reconciliation at transfer is to ensure all medications are appropriate for the patient’s new status of care. The process involves assessing and accounting for: ● ● ● The best possible medication history (BPMH) is created prior to writing admission medication orders. Medications the patient was taking prior to admission (BPMH). Medications the patient has received since admission (MAR). New post-transfer medication orders (including new, discontinued and changed medications upon transfer). The admission orders are written before the BPMH is created. TRANSFER DISCHARGE The importance of medication reconciliation at discharge is to reduce the chance of adverse drug events especially for patients taking multiple medications. ● ● ● We want to communicate an up-todate, complete and accurate list of medications the patient is taking to the next provider. Medication discrepancies commonly occur at discharge when prescriptions are written and discharge prepared. Patients with one or more drugs omitted from their discharge summary have 2.31 times the usual risk of readmission to hospital.
