1. Discharge Orders/Medication Reconciliation
Medication Education Module 4
Discharge Orders/Medication Reconciliation
Trainer Preparation
Copies of:
-PowerPoint handouts
-Print p. 2 “Objectives” to test staff knowledge before & after the training. (Use as your training documentation.)
-Discharge Orders/Medication Reconciliation Checklist
-Responsibilities in Action (RIA) pages 53-54; curriculum can be downloaded at scroll down to "what would you like to do" and select View MAP training resources and curriculum, then select DDS MAP training resources; once there you will see MAP Curriculum and Adjunct Materials
-Corresponding MAP Policy 13-6

2. Objectives 1. When do I use discharge orders?
2. What is medication reconciliation?
3. What is a transition of care?
What I know about discharge orders before the training: 1. 2. 3. 4.
What I learned about discharge orders after the training:
4. What do I tell the PCP?

3. Discharge Orders
Discharge (new) orders from a Health Care Facility take the place of prior existing orders
Examples of a Health Care Facility are a hospital, nursing home, crisis stabilization unit, rehabilitation center, etc.
An Emergency room visit is not considered an admission therefore orders obtained during an emergency room visit are in addition to the current HCP orders in the residence.

4. Medication Reconciliation
Comparing an individual’s new medication orders to all of the medication orders that were in place prior to the new orders
Must be done during every transition of care
Examples of transition of care include transfer to/from a hospital, nursing home, crisis stabilization unit, rehabilitation center.

5. Before Discharge Obtain
PCP orders from individual’s home before admission
HCP discharge (new) orders

6. Before Discharge Compare the meds on the two sets of orders
New and Prior
Pay attention to possible dose and/or frequency changes for meds that appear on both sets of orders

7. Before Discharge
Review any discrepancies between the two sets of orders with the HCP

8. Before Discharge Obtain signed, dated HCP orders
If more than 1 page, HCP must sign and date each page
Electronic signatures are acceptable

9. Before Discharge
Obtain new prescriptions or ensure the pharmacy has been notified by HCP of new medication prescriptions

10. After Discharge
Notify PCP and any other prescribing HCP that the individual had a transfer of care

11. After Discharge Notify PCP and any other prescribing HCP of
New or changed medication/treatment orders
Previously ordered medications omitted from HCP discharge orders
Document

12. After Discharge Obtain from PCP and any other prescribing HCP
New orders for any previously ordered medications [omitted from HCP discharge orders] that they want reordered
Orders must be re-written
Statements such as resume all meds as previously ordered are not acceptable.

13. After Discharge Obtain newly prescribed medications from pharmacy
Transcribe new orders (previous transcriptions may not be used)
Post and Verify all orders
Communicate changes
Map Policy When a medication had been previously transferred (such as a hospital), the medication may be returned and used as long as:
-there is a current order for the medication
-the label agrees with the order (there are no hand printed changes on the label)
-the directions have not changed
-the medication is in a tamper resistant package
-a dated medication release form has been signed (hospital licensed staff/MAP Certified staff)
Make sure other coworkers, supervisor, day program staff, family members, etc. involved in supporting the individual are aware of changes.

14. Discharge Checklist
The Discharge Checklist may be used as a resource tool in the medication reconciliation process.
To locate the Discharge Checklist page 54 in RIA or page 144 in the MAP Policy Manual.

15. Questions

16. Resources MAP Curriculum- Responsibilities in Action
MAP Policy Manual