1. Medication Reconciliation: Partnering with the Community What worked, what didn’t ! October 2010 Ann Nickerson BSc (Pharm) Susan Crawford RN Extra Mural Driscoll Unit Moncton New Brunswick Ann.Nickerson@horizonnb.ca Susan.Crawford@horizonnb.ca

2. Acknowledgement Thanks to the other Extramural Driscoll Medication Reconciliation Team members: Cheryl Leger, RN Joan Peddle, RN,BN; Maura Dalton, RN, BScN; Linda Price, RN,BScN; Margaret Meier RN,BScN

3. 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?

4. THE RIGHT TIME Transition Points Admission Transfer to another setting, service provider or level of care within or outside the hospital setting Discharge to the community Over half of all hospital medication errors occur at interfaces of care Rozich, Resar (2001) J Clin Outcomes Manage.

5. 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 histories Community pharmacist, physicians and nurses from various levels of service in the community and hospital and risk manager

6. 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

7. 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.

9. “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

10. 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

12. 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.

13. 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

14. Eye/Ear Drops Inhalers Nasal Spray Patches Liquids Injections Ointments/Cream When talking with your doctor, nurse, or pharmacist always remember to include medicines you take every day, but also include ones you only take sometimes such as for a cold, stomachache or headache.

15. Form Completed by: Signature:________________________ Designation: ________ Date: ____________

16. Eye/Ear Drops Inhalers Nasal Spray Patches Liquids Injections Ointments/Cream When talking with your doctor, nurse, or pharmacist always remember to include medicines you take every day, but also include ones you only take sometimes such as for a cold, stomachache or headache.

17. 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

18. 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) 35 th U.S. President