DISTRICT MEDICATION RECONCILIATION AND ADMINISTRATION Adapted from Medication Reconciliation from the QSEN website Originally developed by Judy Young, RN, MS Lecturer Indiana University School of Nursing

Purpose of the learning activity The purpose of this learning activity is to enhance your understanding of medication reconciliation as a quality improvement measure to enhance patient safety and prepare you to perform medication reconciliation on a client in the clinical setting. Moreover, this activity will give you an opportunity to practice the six rights and three checks of medication administration to a group of clients. This learning activity uses five simulated clients who require medication administration using the electronic medication cart. Prior to performing district medication administration in the nursing lab for these clients, you will review the standards for medication reconciliation and apply your clinical reasoning skills to identify.

Review of medication reconciliation What is medication reconciliation? The process of identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider. Why is it so important? To prevent numerous prescribing and administration errors. Which Joint Commission NPSG does it meet? Medication Safety: Goal 3: Improve the safety of using medications What EHR certification criteria does it meet? Clinical Information reconciliation 2014 Edition EHR certification criteria focuses on the reconciliation of data in each of a patient’s medication, problem, and medication allergy lists.

Difference between clinical information and medication reconciliation Certified Electronic Health Records (EHR) will perform clinical information reconciliation: Requires providers to reconcile the problem list and medication allergy lists in addition to the medication list in medication reconciliation

Steps for medication reconciliation are developed by the agency SCCC steps for this exercise: 1. Develop a list of current medications, herbal supplements, OTC drugs, vitamin and minerals from home prior to admission; 2. Develop a list of medications to be prescribed during admission 3. Determine if prescribed medications are within the standard of care for the client’s problem 4. Compare the medications on the two lists 5. Make clinical decisions based on the comparison Seek clarification with health care providers as to what medications should continue, hold or discontinue 6. Create a comprehensive list to communicate to appropriate caregivers and to the patient.

Gather Materials You will need: Internet access to view patient chart information a reconciliation form for each assigned patient See next slide for completion instructions A current drug guide or electronic access to Daily MedDaily Med

Review of reconciliation form 1.Enter sources; pt, family, records as appropriate 2.Print medication information in space provided 3.Indicated when medication was last taken 4.Circle “c” if continued on admission or “DC” if discontinued 5.Place a check in the box for “Drug clarification required” if the review of client information; clinical status, labs, condition indicate that you need to talk with the prescribing physician 6.Place a check in the box for “Dose clarification required” if the review of client’s medication dose is inconsistent with standard of care, clinical condition or previously prescribed amount. Explain rationale in section labeled: “clarification/concern” for patient list, orders and MAR in the Medication Reconciliation worksheet

Let’s begin…. You are the nurse assigned to an acute care medical surgical unit. The EHR system was down for the past three days due to system-wide disruption. The hospital was using a backup paper record system during the failure. While records are starting to be added to the EHR, it will require additional time. The Computer physician order entry (CPOE) has been restored and the electronic medication cart is in use. Due to the disruption in the EHR, standard physician order sets were not employed, so physician orders need to be reconciled with the standard order sets as well. You have been assigned district medications for four patients. Let’s meet your patients…