PowerPoint Presentation

Medication ReconciliationConcord Regional Visiting Nurse Association Spring 2012

1Medication Reconciliation* is the process of identifying the most accurate list of all medications a patient is actually taking including name, dosage, frequency, and route. The information is then used to determine which medications the patient should be taking per physician orders.

The Medication Reconciliation process for home care has three basic steps:

Verify - Collect an accurate medication list

Clarify - Clarify any questions about drug/dose/frequency

Reconcile - Communicate with physician about any identified medication questions or concerns.

*Adapted from the Institute for Healthcare Improvement

22Medication reconciliation is a formal process in which health care professionals partner withclients and families to ensure accurate and complete medication information transfer atinterfaces of care.It involves a systematic process for obtaining a medication history, and using that information tocompare to medication orders to identify and resolve discrepancies. It is designed to preventpotential medication errors and adverse drug events

Medication reconciliation is NOT the clinician only looking at the patients hand written list or discharge summary without looking at every bottle the patient takes. Never assume the patient list/discharge list is correct or reflects what the patient is actually taking. The first step in the Medication Reconciliation process is to collect a COMPLETE list of ALL medications that the patient is currently taking. This includes:Prescription medicationsOver-the-counter medications such as aspirin, acetaminophen, NSAIDs, Benadryl for sleepCulturally-based home remedies, such as:Ginseng (for physical and mental performance, infection resistance)Chamomile tea (for sleep/anxiety)Over the counter herbal products, such as:St. Johns Wort (for depression, stress, anxiety)Senna (for constipation)Black Cohosh (for menopause symptoms)Dietary supplements such as Calcium (to prevent osteoporosis)Vitamins such as Niacin, Vitamin E, Vitamin D

The Medication Reconciliation Process Step 1 Verify

33Scripts to help verify the medications a home care patient is taking1.In addition to the medications ordered by your doctor are you taking any other pills, vitamins or minerals?2.Do you have any other pills or other medications in your:Kitchen BedroomBathroomPantry or linen closetAnywhere else?\Do you take any vitamin or mineral supplements?Do you take any herbal remedies like Sleepy Time Tea?Do you regularly take an over-the-counter medication for:ConstipationDiarrheaPain like a headache, arthritis, muscle achesSleepHeartburnUpset stomachSkin problems*******************************************************************1. Do you take any other pills on a regular or occasional basis other than what your doctors have ordered? 2. Any other over the counter medications such as pain relievers or laxatives?3. Do you take any vitamins or herbal supplements?*******************************************************************What prescription medications are you currently taking?What other non-prescription medications do you take?If response is none/nothing:Verify: Any herbals, vitamins, over-the-counter pain medicine like Tylenol, Ibuprofen? Any laxatives?Hint: Many elderly people take 81mg aspirin a day, Tylenol PM at bedtime, laxative & supplements (multivitamin, iron)

It is important to specifically ask about the use of non-prescription medications and preparations patients often do not consider things such as vitamins medications and will not volunteer that they are taking them.Other tips for obtaining more complete medication lists at the start of home care:Tell the patient/family BEFORE the first visit to collect all of the patients medications and have them ready for the nurse to see.Ask the patient what help they think they might need in managing their medications.

The Medication Reconciliation Process Step 1 Verify

44The next step is to clarify any medication names, doses, frequencies, and to identify combinations that may be contraindicated or medications that seem to be inappropriate.

In the Clarify step, a key goal is to identify potentially serious drug/drug interactions or therapeutic duplication within the patients medication list.

Therapeutic duplication is present when the patients medications include two or more medications from the same chemical family or therapeutic class.

A possibility for drug/drug interaction (DDI) is present when the patients medications include two or more medications with the potential to interact negatively with one another.

The Medication Reconciliation Process Step 2 Clarify

55Our software allow us to check for interactions. Assess the patient, listen to what they tell you. Could some of their symptoms be related to medication problems?

6After entering medications into the clinical system, you are asked to check for adverse reactions. If patients have interactions that equal a 1 or 2 you are to call the physician to notify them of the alert and document. Adverse reactions of 3 + use your clinical judgment based on clinical symptoms the patient has. 6Besides looking for therapeutic duplication and drug-drug interactions, the reconciliation process should identify any potentially inappropriate medications. Certain medications should generally be avoided in older persons although a physician may decide that their use for an individual patients specific clinical circumstance is appropriate. One such list of medications is called the Beers Criteria.

The Medication Reconciliation Process Step 2 Clarify

77We use the Beers criteria which is based on a consensus derived from an expert panel that reviews scientific literature. The list is intended to assist clinicians in adopting evidence-based prescribing practices. When you encounter a patient receiving a potentially inappropriate medication, refer to the Beers criteria, clearly articulate your concerns with a description of assessment findings to the prescriber. The third step in the home care medication reconciliation process is to reconcile the medications with the physician.

If the patients medication list is free from therapeutic duplication , potentially inappropriate medications, and no dose, route or frequency questions have been identified, the completed medication list can be entered in section 10 on the HCFA Form 485 and sent to the physician for verification and signature.

If a question or potential problem has been identified, the nurse (or therapist) is responsible for ensuring that these are reported to the physician, and for obtaining clarification or revised orders.

The Medication Reconciliation Process Step 3 Reconcile

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