Transcript Med Rec Screen Saver Medical Pharmacies

Medication
Reconciliation in
Long Term Care
Medication Reconciliation, or “Med
Rec”, is a formal process of creating
a Best Possible Medication History
(BPMH)…and using it when writing
medication orders
Compare the Best Possible Medication
History (BPMH) against physician’s
admission, readmission/transfer or
discharge orders
Identify any discrepancies and alert the
physician or other health team members
Why is Med Rec
Important?
Research suggests medication errors
can be decreased by using this process. The
Institute for Healthcare Improvement has
suggested that as many as 50% of
medication errors could be prevented by
using an effective Medication Reconciliation
Process
Why is Med Rec
Important?
 Ensures accuracy and continuity of medication orders
 Reduces potential adverse effects and harm related to changes
or loss of information during transfers to other health care settings
 Avoids unintentional changes in therapy
 Increases safety for resident
When Should Med
Rec be done?
Transitions of Care such as:
 Resident admission
 Resident readmission/transfer
 Resident discharge
Medical
Pharmacy’s
new “OneWrite” BPMH
form
Use it to create
a BPMH list for
ALL residents
on admission or
readmission
How do I
create a
BPMH?
Use multiple (at least 2) sources
for information, such as…
 resident and/or family
 medication vials, wallet cards
 previous pharmacy
 family physician and specialists
 discharge note from hospital
 previous MAR
 CCAC information
What do I include on a BPMH?
 All current and relevant past
prescription medications
 Non-prescription medications
 Complimentary/alternative and
herbal medications
 Include indication, dose, dosage
form, route, level of patient
adherence
Remember to ask about:
 Eye drops, inhalers, patches, sprays
 Vaccines
 Samples or investigational
medications
 Allergies to medications…including
the nature of the “reaction”
Remember…
Resident’s
ACTUAL
Medication Use
≠
Resident’s
PRESCRIBED
Medications
Use Resident/family interview, CCAC lists, discharge
lists or MARs to compare to prescription lists from
vials, Dr., pharmacist, medical chart
Best Possible
Medication History
Resident/Family Interview TIP:
Use Medical Conditions as a trigger to
prompt consideration of all medications
Best Possible
Medication History
Resident/Family Interview TIP:
Use Open-ended questions like:
“How do you take this medication?”
Med Rec on Transfer/Discharge
When a resident is transferred to another facility or
discharged, a copy of current MAR reconciled with
physician’s orders must be provided to receiving facility
MAR
MAR
MAR
MAR