Transcript Admission Home Medication Reconciliation Report

Reports Instruction
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Medication Reconciliation Report
 To complete the medication reconciliation report,
check EITHER the box “CONT” to continue OR
“STOP” to discontinue the home mediation.
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Admission Home
Medication Reconciliation Report
• If you wish to continue the home medication on admission
o Check “CONT”
• If you wish to change the home medication on admission
o Check “CONT”
o Make the changes by clearly marking out text you wish to change
and clearly writing the change you wish to make in the
appropriate space on the form.
• If you wish to discontinue the home medication on admission
o Check “STOP”
o This mean the specific home medication order will not be
continued as inpatient medication.
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Admission Home Reconciliation Report
Therapeutic Substitution
 If a patient is on Lotrel 10/20 on Home Med list.
 Check “CONT” Home Medication Lotrel 10/20.
 Pharmacy will dispense per Hospital Formulary or
clarify with you.
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Discharge Medication Reconciliation Report
Same Medication, Same Doses
 When a medication is listed exactly the same under both
“Home Medications” and “Active Pharmacy Medications”,

Check “CONT” the Home Medication and “STOP” the
Active Pharmacy Medication.

DO NOT CONTINUE BOTH.

NOTE: If you check to continue both medications, you will
be called for clarification.
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Discharge Medication reconciliation Report
Same Medication, Different Doses
 When a medication is listed under both the “Home
Medications” and “Active Pharmacy Medications”, but the
dosage or frequency is different,
 Check “CONT” the “Home Medications” and make the
dosage/frequency changes on the Home Medications
and
 STOP” the Active Pharmacy Medication.
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Discharge Medication Reconciliation Report
Therapeutic Duplication
 If a patient is on Lotrel 10/20 on Home Med list that was continued on
admission, and Active Pharmacy Medication is 10/20
 If you wish the patient to continue with Lotrel 10/20,

Check to “CONT” the Home Medications 10/20.
 If you wish the patient to increase the dose to Lotrel 10/40,


Check to “CONT” the “Home Medications”, cross out 10/20 and write 10/40.
“STOP” the “Active Pharmacy Medications” 10/20.
 If you want the patient to start the new dosage Lotrel 20/40,

Check to “STOP” both “Home Medication” and “Active Pharmacy
Medication”. Write a “NEW” order for 20/40.
 NOTE: If you check to continue both the combination medication and either or both
of the separate medications, you will be called for a clarification.
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Discharge Medication Reconciliation Report
Therapeutic Substitution
 EXAMPLE: If the patient has an Aciphex 20 mg that
was continued on admission, but therapeutically
converted to Protonix 20 mg, the home medication list
will have Aciphex and the active pharmacy medication
list will have Protonix.
  Check “CONT” Home Medication Aciphex 20 mg
(that is listed on the Home Medication section) and
  “STOP” Active Pharmacy Medication – Protonix
(that is listed on the active pharmacy medication
section )
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Discharge Medication Reconciliation Report
New Discharge Medications
 Write on the last page of the report in the ADDITIONAL
MEDICATION ORDERS SECTION, or
 On a separate order sheet attached to the Discharge
Med Reconciliation Report.
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Physician Signature
 Initial each page of the Medication Reconciliation
Report.
 Sign, date and time the last page of the
Medication Reconciliation Report.
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How is the Discharge Physician Med Rec List sorted?
 It is sorted by drug class, then alphabetic by Generic
 Some medications may fall into more than one drug
class but will only list once.
 Since medications may fall into more than one drug
class; the side-by-side Med Rec list would not work.
Cardiovascular
Drugs
Central
Nervous
System Agents
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Why can’t we have the check off box for “Contact PCP
on home medication”
 To promote patient safety, physicians are required to reconcile all
patient home medications on admission, transfer and discharge.
 Medication reconciliation is defined as “Provide the patient (or
family) as needed with written information on the medications the
patient should be taking when he or she is discharged from the
hospital or at the end of an outpatient encounter (e.g., name,
dose, route, frequency, and purpose).
 “Resume all home medications” or “Contact PCP on home
medication” is not compliant with regulatory agencies standard.
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Why are the OR/PACU medications printed on the
Transfer/Discharge Physician Med Rec List?
 All active medications for inpatients and outpatients
are listed in the physician Med Rec Report.
 There is a new Outpatient Report that can be used for
outpatient and procedural areas.
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Can Corporate gray out Active Med List when printing
the report?
 No, Corporate / Meditech has researched the issue. It is unable to
gray out “Active Med List”
 When printing Med Rec report, “Other Reports” must be checked off
and click the drop down box to select one of the Med Rec reports.
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