1. Medication Reconciliation and MedsCheck Initiative with Community Pharmacists
Alice Hogg, RPh
Shellyna Moledina, RPh
Patricia Brown, RPh
May 6, 2008

2. Medication Reconciliation What Is It?
A process where medications are compared at interfaces of care
Discrepancies are identified and reconciled with the physician
Intervention minimizes patient harm from unintended discrepancies

3. Best Possible Medication History
BPMH is a list of what the patient is actually taking (not necessarily just what was prescribed)
Gathered by using more than 1 source of information (e.g. MedsCheck, patient interview, medication vials, Drug Profile Viewer, medication profile, community pharmacist, family physician)
identify and resolve discrepancies between what was ordered and what the patient is actually taking
contact the physician to resolve discrepancies

4. Why is the BPMH useful?
Helps to ensure home medications are continued in hospital if appropriate
Helps to resolves discrepancies between what was ordered and what the patient was actually taking prior to admission
Ensures continuity of care

5. 2008 ISMP Canada MedRec/MedsCheck Hospital Project
10 hospital sites
Pre-admission surgical clinic - elective patients
Asking patients for a MedsCheck to be done prior to admission to the hospital
RN gathers Best Possible Medication History at preadmission clinic
Using MedsCheck as the primary source of information
Measure the value and impact of the MedsCheck program to MedRec in hospital

6. MedsCheck Ministry of Health and Long-Term Care

7. Community Pharmacist’s Role
Accommodate patient’s requests for MedsCheck or Follow-Up prior to their pre-admission clinic appointment. (1-2 weeks)
Record all the medications the patient is actually taking even if it differs from the prescribed instructions.
The profile should include all current prescription and over-the-counter medications.

8. What is the effect on Patient Care?
Develops and strengthens the relationship between patients and their community pharmacist.
Improves seamless care between the community and hospital to ensure patients receive medications correctly and appropriately between transfers of care.
Prevents medication errors and improves the efficiency and accuracy of the medication ordering process in hospital.
Impacts the entire continuum of care

9. Linking MedsCheck to Medication Reconciliation
Coordinating MedsCheck and medication reconciliation in Ontario will contribute to the seamless transfer of accurate information and contribute to the improvement of patient care and safety.