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 “One-Write” BPMH form Use it to create a BPMH list for ALL residents on admission or readmission

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 How do I create a BPMH?

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