1. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Home & Community Care Medication Reconciliation

2. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Medication Reconciliation Process Medication Risk Assessment Tool (MedRAT) identifies high risk clients requiring medication reconciliation Best Possible Medication History (BPMH) completed and sent to Physician for reconciliation MedRAT and BPMH also sent to participating Community Pharmacists for in-depth medication review

3. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative MEDICATION RISK ASSESSMENT TOOL 1. IS THE CLIENTS MEDICATION REGIMEN Simple Complex (please see reverse for more information) 2. IS THE CLIENT’S MEDICATION ADHERENCE BEST DESCRIBED AS: Taking as prescribed Chaotic (If chaotic, tick possible reasons below) ____ Impaired cognition ____ Impaired vision, hearing, swallowing ____ Lacks necessary support ____ Lower literacy or ESL issues ____ Side effects ____ Cost ____ Client’s beliefs/expectations ____ Lacks basic understanding of medications ____ Other (describe) _________________________________________ 3. IS THE CLIENT ON ANY HIGH-RISK MEDICATIONS? ( see reverse for more information)

4. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative MEDICATION RISK ASSESSMENT TOOL Examples of factors which increase complexity in a medication regimen: Greater than 5 medications (include prescription, OTCs, herbals, etc) Greater than 3 times a day dosing frequency More than 2 methods of medication administration – eg: oral, drops, patches, nebulizers, etc More than 2 prescribers More than 2 pharmacies (include online pharmacy, if clients are using that) Many OTC/herbal/alternative products Multiple caregivers involved in medication administration (consider family, neighbours, friends, Community Health Workers, etc) Medications or doses changing frequently

5. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative MEDICATION RISK ASSESSMENT TOOL Examples of chaotic medication adherence: (Occasional missed doses are considered “normal”) No evidence of organized approach to medication administration Blisterpacks that appear to be randomly punched out Medications left out of containers and lying around the house Client stating they’re not sure when they last took medications or that they know they are forgetting some doses (more than occasionally), or that they’re “mixed up” about their medications

6. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative MEDICATION RISK ASSESSMENT TOOL High-risk medications: These medications are especially problematic for people in the over 65 years of age group, but also carry some risk for those under 65: Narcotics NSAIDs – eg: Advil, Ibuprofen Anxiolytics – eg: Ativan, Buspirone Antipsychotics Digoxin Anticoagulants – eg: Warfarin Dilantin Antihistamines Tricyclic antidepressants – eg: Amitriptyline Beta-blockers Insulin

7. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Best Possible Medication History Sources of Information 1.Client Referral Form/Home Care Admission Orders 2.Client/Family/Caregiver 3.Acute Care Medication List/Profile 4.Discharge Orders/Prescriptions 5.RAI (Date RAI completed)____________ 6.Provincial Drug Database 7.MAR 8.Medication Vials/Containers/Bubblepacks 9.Community Pharmacy

8. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Tools BPMH form Picture Tool Tips for Taking a Medication History

9. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Best Possible Medication History Home & Community Care Medication Reconciliation ALLERGIES: Home Medication Profile: PHYSICIAN INSTRUCTIONS  Please confirm the following medications currently being taken at home by ticking the appropriate boxes marked YES, NO or CHANGE.  If any medications are to be discontinued or changed complete the physician orders attached, including reason for change and send prescription to the Pharmacy.  Please Sign and Date at the bottom of the page where indicated

10. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Best Possible Medication History Categorization of Discrepancies: 0. No discrepancy 1. Med not currently prescribed 2. Different dose 3. Different frequency 4. Different route 5. Client no longer taking med 6. OTC – not taking as directed 7. Other

11. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Best Possible Medication History Home & Community Care Medication Reconciliation ALLERGIES: Home Medication Profile:  The following is a list of all the non-prescribed medications this client is taking including the over the counters (OTC) and Herbal medications  Please review as may have potential for interactions  Please Sign and Date at the bottom of the page where indicated

12. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Best Possible Medication History Home & Community Care Medication Reconciliation ALLERGIES: PHYSICIAN ORDER for new or changed home medication (if CHANGE box ticked)

13. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Picture Tool 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. DON’T FORGET THESE TYPES OF MEDICATIONS Eye Drops Injections Liquids Patches Nasal Sprays Inhalers Ointment/Creams

14. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Tips for Taking a Med History TIPS FOR TAKING A MEDICATION HISTORY Question 1 relates to MedRAT Question 1 – simple vs complex medication regimen 1)A complete medication profile – principle of “respectful sleuthing” Names/phone no’s of all pharmacies used (check re use of online drug ordering). Confirm client’s allergy list and describe any reactions to meds Questions 2 and 3 relate to MedRAT Question 2 – adherence vs chaos 2)Client’s perception of purpose of medications Should know the basic names and purposes of each medication. Client’s perception of effectiveness of medications 3)Client’s ability to self-administer medications Cognitive status – judgment, reasoning, understanding, diagnosis of dementia, cognitive testing Any physical/sensory/emotional barriers – fine motor control, vision, swallowing, motivation

15. Coming Full Circle: AMI & Med Rec Across the Continuum Western Node Collaborative Plan For Spread Integrate MedRAT into common practice for Nurses and Case Managers Expand conditions for testing Med Rec process - additional clinicians in Duncan - SARIN Case Managers and HF Nurse - another HU in South Island Hold the gains obtained and plan spread to other Health Units