Medication Reconciliation A Basic Overview

Hi everyone, in this presentation I have shared a basic overview of Medication Reconciliation and its benefits & challenges.
However, this is for education & information purpose only.

1. MEDICATION
RECONCILIATION:
A BASIC OVERVIEW
PRESENTED BY
ANUPAM DAS
B.Sc. (MICROBIOLOGY), MBA –HEALTHCARE MANAGEMENT

2. BACKGROUND
Patientsoftenreceivenewmedicationsorhavechangesmadeto
theirexistingmedicationsattimesoftransitionsincareupon
hospitaladmission,transferfromonedepartment/unittoanother
duringhospitalization,ordischargefromthehospitaltohomeor
anotherfacility.

3. WHAT IS MEDICATION RECONCILIATION
■Medicationreconciliationisaformalprocessortechniqueusedby
clinicalpersonnel(e.g.doctors,nursingstaffandpharmacists)to
gatheracompleteandaccuratelistofapatient'sprescribedand
homemedicationstoidentifydiscrepanciesindrugregimensin
differentlevelsofcare,healthcaresettings,orpointsintimeandto
usethatinformationtoinformprescribingdecisionsandidentifyand
preventmedicationerrors.
■Inshort,itisaProcessofidentifyingthemostaccuratelistofall
medicationsapatientistakingincludingname,dosage,frequency&
routeandtousethislisttoprovidecorrectmedicationsforpatients
anywherewithinthehealthcaresystemandmostimportantly,
comparethepatient'scurrentmedicationlistagainsttheadmission,
transferordischargeorders

4. GOALS OF MEDICATION RECONCILIATION
■Topreventadversedrugevents(ADEs)atallinterfacesofcare(admission,transferand
discharge),forallpatients.
■Toimprovethesafetyofusingmedications.
■Toensurethesafetyofallpatientsagainstmedicationerror.
■Toeliminateundocumentedintentionaldiscrepanciesandunintentionaldiscrepanciesby
reconcilingallmedications,atallinterfacesofcare.
AnundocumentedintentionaldiscrepancyoccurswhenthePhysicianintentionallyadds,changesor
discontinuesamedicationthepatientwastakingpriortoadmissionbutthisisnotclearly
documentedinthepatient’smedicalrecord.
Anunintentionaldiscrepancyoccurswhenthephysicianunintentionallychanges,addsoromitsa
medicationthepatientwastakingpriortoadmission.

5. EXAMPLES OF MEDICAL RECONCILIATION
ExampleofanUndocumentedIntentionalDiscrepancy
Apatientreceivingatenololforhypertensionwasadmittedforsurgery.Theadmitting
residentdidnotorderatenololonadmissionduetoconcernsaboutperioperative
hypotension.Thereasonfornotorderingatenololwasnotdocumentedinthemedical
record.Thepatientwasdischargedonthethirdpostoperativedayandwasgivena
dischargeprescriptionthatdidnotincludeatenolol.Thepatientwasunsurewhether
toresumetreatmentwithatenololathomeandcalledherfamilydoctorforadvice.
Thefamilydoctorcalledthepatient’ssurgeontoclarifythediscrepancy.Thesurgeon
didnotknowwhytheatenololwasstoppedwhileinhospitalandcalledthehospital
pharmacy.Thepharmacydidnothavearecordofthechangesothepharmaciston
thesurgicalunittriedtocontacttheadmittingresidentbuttheresidentwasnolonger
ontheservice.

6. EXAMPLES OF MEDICAL RECONCILIATION
ExamplesofanUnintentionalDiscrepancy
Anelderlywomanwasadmittedtoageneralmedicineunitwithadiagnosisof
community-acquiredpneumonia.Antibioticsandsymptommanagementwereordered
andstarted.Twodayslaterthepatienthadamyocardialinfarctionanditwasfound
thatabeta-blocker(cardiacmedication)hadbeenunintentionallyomittedon
admission.
Apatientwasadmittedfortotalkneereplacementsurgery.Afterfourorfivedaysthe
patientwasnotmotivatedandrefusedtogetoutofbed.Thefamilymentionedtothe
nursethatthepatienthadbeenonanantidepressantmedicationpriortoadmission
andithadnotbeenorderedwhileinhospital.Themedicationwasordered.Ittook
approximatelyoneweekforthemedicationtoworkagain,resultinginaprolonged
hospitalstay.

7. STEPS OF MEDICATION RECONCILIATION
Therearefollowingbasic,butveryimportantstepsofMedication
Reconciliation.
■Verification:Collectionofcompleteandaccuratemedicationlist(including
current&pastmedication)ofpatientandothermedicationinformation.
■Clarification:Ensuringthedosageandmedicationsareappropriateforthe
patient.
■Reconciliation:Resolvingdiscrepanciesanddocumentingchangesandnew
orders.
Althoughtherequiredstepsseembasic,thelogisticsbehindwhen,where,how,andbywhomthisisdonecanbedifficult.

8. BENEFITS OF MEDICATION RECONCILIATION
■Obtain and maintain a complete list of medications
the patient is regularly taking.
■Reduction in medication error and adverse drug
events.
■Patients receive appropriate medication.
■Improve effective communication between clinical
personnel and patients & their family members.

9. CHALLENGES OF MEDICAL RECONCILIATION
■TIME TIMETIME..!! –Biggest Challenge.
■Patient’s inability to recall medications, its dosage and
frequency.
■Unreliable sources of medication information
■Skill level of interviewer of patients.

10. CONCLUSION
MedicationReconciliationhasbeenincreasing,
morestudiesareneededontheimplementationand
adoptionofeffectivemedicationreconciliation
processes,withemphasisontheidentificationof
currentbestpracticesformedicationreconciliation.

11. REFERENCES
■ApproachtoImprovingSafety:MedicationReconciliation(Agencyfor
HealthcareResearch&Quality)
■MedicationReconciliationAccordingtotheJointCommission,S.
MichaelRoss,MD,MHA
■MedicationReconciliation:ALearningGuide,Queen’sUniversity–
OfficeofinterpersonalEducation&Practice
■EnsuringMedicationReconciliation,ByKristenGeorgia,BS;Kristin
Kinney,RN,MSN;AngelaPace,RN,MSN;andKimHelton,RN,BSN
■ImprovingCareTransitions:OptimizingMedicationReconciliation,
Developedby:AmericanPharmacistsAssociation,AmericanSociety
ofHealth-SystemPharmacists

12. THANK YOU