1. Medication Reconciliation ROP Compliance
Medicine Accreditation 2016

2. What Is Medication Reconciliation (Med Rec)?
It is the process in which healthcare providers work collaboratively to identify the most comprehensive and accurate list of medications for the patient/resident as they move from one level of care to another.
This list is compared with the current medication orders and any discrepancies are reconciled.

3. Research
More than 50% of clients have at least one discrepancy between the medications they take at home with those ordered upon admission to the hospital
Many of these have the potential to cause adverse drug events

4. Major Tests for Compliance
Upon or prior to admission, A best Possible Medication History (BPMH) is generated and documented, in partnership with clients, families, caregivers, and others, as appropriate.

5. What Is a Best Possible Medication History?
The health care team is responsible to ensure a Best Possible Medication History (BPMH) has been completed on admission.
The BPMH is a complete list of the patient/resident’s current medications including prescription and non-prescription medications.
The history should include how the medications are actually being taken in addition to how they may have been ordered.

6. Major Tests for Compliance
The BPMH is used to generated admission medication orders or the BPMH is compared with current medication orders and any medication discrepancies are identified, resolved and documented

8. How is a BPMH obtained?
Information is gathered through patient and family interviews, medication records and pharmaceutical reports.
Once verified, this information assists in identifying and bringing any medication discrepancies to the attention of the care team.

9. How is the BPMH used?
The BPMH is used to provide the most comprehensive and accurate list of medications a patient is taking to ensure correct medications are prescribed.
At admission the BPMH is used as/or with the admission orders and is one component used to create a MedRec on external transfer/discharge medication order.

10. What does it mean to reconcile medication orders?
Reconciling admitting, transfer or discharge medication orders is to:
Compare the BPMH to the admitting, transfer or discharge medication orders, make note of any discrepancies and follow-up with the responsible prescriber to resolve discrepancies
(i.e. medications not accounted for on medication orders).

11. Major Tests of Compliance
A Current Medication List is retained in the client record

12. Where does the BPMH go in the chart?
The BPMH should be placed in the patient care orders section. This document follows the patient through all levels of care. DO NOT THIN from chart.

13. Major Tests for Compliance
The prescriber uses the BPMH and the current medication orders to generate transfer or discharge medication orders.

16. Do I still need to complete the BPMH if the admission orders were already written for the patient/resident?
Yes, as per Accreditation Canada, Medication Reconciliation MUST be completed at key transitions of care (which includes admission).
If orders have already been written, the BPMH is completed and then reconciled with the admission orders.
This is called the Retroactive/Retrospective Model and is usually used at sites/units where there are high admission volumes and the patient/resident requires immediate treatment
Any discrepancies between the admission orders and the BPMH must be reconciled.

17. What if I can’t ask the patient/resident about their medications?
A quality BPMH should include at least two sources of information. If you cannot talk to the patient directly, ask a family member, consult Netcare PIN, phone their pharmacy, or contact their primary physician.

18. What if the patient/resident says they are taking a medication different than prescribed?
Indicate on the BPMH tool how the medication is ACTUALLY being taken and make a note in the comments section how it was prescribed.

19. Impact on Nursing Staff
MedRec can reduce workload and rework associated with medication management
Nurses will spend less time tracking down and contacting prescribers to clarify and address discrepancies in medication orders.
Nursing staff have been noted to spend in excess of an hour per patient on admission or transfer trying to accurately identify medication a patient has been receiving.
MedRec reduced nursing time at admission by over 20 minutes per patient

20. Impact on Nursing Staff
MedRec leads to better collaborative communication and better information Nurses have a role in educating clients about their medication regime, advocating for their needs and supporting them to be co-managers in their care When MedRec is completed at each transition of patient care, the patients and all healthcare providers will have an accurate medication list. This aims to eliminate unintentional discrepancies and undocumented intentional discrepancies.

21. Impact on Nursing Staff
• Evidence suggests RNs are well-positioned to intercept medication errors
Med Rec is a shared professional responsibility, supported by a study showing interception on 86% of potential medication errors.

22. Impact on Nursing Staff
• The Canadian Nurses Protective Society highlights that nurses, as both health care providers and patient advocates, play a key role in patient safety.
MedRec is a major patient safety initiative to improve communication about medications as patients transfer though healthcare settings
A study found that more than 1 in 9 emergency department visits were due to drug related adverse events.

23. Questions?