Medication Reconciliation:Partnering with the Community

What worked, what didn’t !October 2010

Ann Nickerson BSc (Pharm)Susan Crawford RN

Extra Mural Driscoll UnitMoncton New Brunswick Ann.Nickerson@horizonnb.caSusan.Crawford@horizonnb.ca

Acknowledgement

Thanks to the other Extramural Driscoll Medication Reconciliation

Team members:

Cheryl Leger, RNJoan Peddle, RN,BN;

Maura Dalton, RN, BScN; Linda Price, RN,BScN;

Margaret Meier RN,BScN

SELF ASSESMENT QUESTIONS

What are the critical steps and questions in the process of medication reconciliation and taking of the best possible medication history (BPMH)?

What key transition areas in my practice setting are problem-prone points in our medication management system?

THE RIGHT TIME

Transition PointsAdmissionTransfer to another setting, service provider or level of care within or outside the hospital settingDischarge to the community

Over half of all hospital medication errors occur at interfaces of care

Rozich, Resar (2001) J Clin Outcomes Manage.

THE RIGHT STAKEHOLDERS

“ Medication reconciliation is a shared responsibility. Communication between the various levels of care/service is vital to accurate medication reconciliation.” CCHA

Suggest: include a hospital pharmacist, a physician and home care RNS &/or those who take the medication historiesCommunity pharmacist, physicians and nurses from various levels of service in the community and hospital and risk manager

THE RIGHT STAKEHOLDERS

FORM THE TEAM-

Become champions for the patient! Result : The safety benefit of an

accurate medication history

It’s so much more than a list

Medication History“Medication-history taking is a skill” NOT a technical responsibility

Aug.1.2005 AJHP News

Remind yourself

“It’s NOT just a list”

Med Reconciliation at the time of admission is ideal.The longer you wait, may delay someone from preventing a medication error.

“I take a small white pill and a large blue pill”

Converse with patient’s community pharmacist, family member, hospital

discharge nurse and most importantly

THE PATIENT

Important Questions

PROMPT the patient to remember patches, creams, eye drops, inhalers, physician samples, shots, herbal, vitamins, minerals

Regularly used OTC products

Allergy VS side effects: Describe the reaction.

Have patients describe how and when they take their medications

Information from the patient

This is the key to a good medication history!

Dangerous practice to record a history JUST from the directions on the medication bottle or print out from the community pharmacy.

The medication history should be “as stated by the patient.” It is from here we can make modifications and actually uncover reasons for admission

E.g.. Patient taking 10mg of paroxetine(Paxil) because 20mg caused diarrhea, shakiness, unsteady on her feet. Label reads 20mg.

Improvement Model

What are we trying to accomplish?

How will we know that

change is an improvement?

What changes can we make that

will result in improvement?

Plan

Do

Act

Study

The Form - Documentation

Customization! Standardization!

Have only ONE area where a patient’s medication history can be recorded

Adopt the medication Reconciliation form as the admitting order for the patient’s home meds

Am.J.Nurs.Vol 105(3) supplement March 2005.31-36

On Action:

“There are costs and risks to a program of action, but they are far less than the long-range risks and costs of

comfortable inaction”

John F. Kennedy (1917-1963)

35th U.S. President