1. Using the CIS for Medication Reconciliation Inpatient Providers

2. Medication Reconciliation
A Joint Commission Patient Safety Initiative with two goals:
Review patient’s current medications on:
Admission (Entry to Children’s)
Transfer between levels of care and providers
Discharge (Exit from Children’s)
Give a complete list of medications to be continued at home to the patient/family on discharge.

3. Process Overview Admission/Transfer
Admission to Hospital
Medication Intake Coordinator (MIC) documents current home medications in the CIS Medication Profile. If there are questions, Pharmacist reviews.
Provider receives Medication Reconciliation alert after MIC documentation/Pharmacy review.
Provider reviews home medications and signs the Medication Reconciliation form.
Transfer between Departments/Services
Provider receives Medication Reconciliation alert.
Provider reviews current and home medications then signs the Medication Reconciliation form.

4. Medication Reconciliation Worksheet for Admissions – Part 1
Print the Medication Reconciliation Worksheet as a reference tool to assist you in:
Reviewing the patient’s home medications
entering the medication orders. (This is easier than toggling between the Medication Profile and the Orders tab.)
To access the Medication Reconciliation Worksheet:

5. Medication Reconciliation Worksheet for Admissions – Part 2
Indicate on the worksheet which medications will be continued during the hospital stay.
Open the CIS and complete the Provider Medication Reconciliation form. (described later)
Order the patient’s medications in the CIS.
Give the worksheet to the admitting nurse so she/he can be aware of which medications will not be given during the inpatient stay.

6. Admission/Transfer Medication Reconciliation Alert
The Medication Reconciliation alert displays when the Provider opens the patient chart after admission or transfer.

7. Admission/Transfer Step 1: Open the Form

8. Admission/Transfer Step 2: Complete the Form

9. Admission/Transfer Step 3: Sign or Close the Form

10. Process Overview Discharge
Discharge from Inpatient (Exit to Patient’s Home)
Provider receives Medication Reconciliation alert after entering an EasyScript home medication or Discharge from Hospital stay order.
Provider reviews patient’s medications for discharge and updates the Medication Profile.
Provider signs the Medication Reconciliation form.
Nurse prints, reviews and gives the Discharge Home Medication List to patient/family.

11. Discharge Medication Reconciliation Alert
The Medication Reconciliation alert displays when the provider enters:
An EasyScript for discharge medications
The Discharge from Hospital Stay order

12. Discharge Step 1: Open the Form

13. Discharge Step 2: Complete the Form and Sign

14. Discharge Nurse Prepares the Discharge Home Medication List
The Nurse:
Prints the Discharge Home Medication List.
Reviews list and if any questions or concerns, asks the provider to address them.
Fills in times for Last Dose and Next Dose
Gives list to patient/family.

15. Key Points
Review patient’s medications and complete the Medication Reconciliation Form at admission/transfer/discharge.
To access the Medication Reconciliation Form: click the Patient Care Activities tab, then the Med Rec sub tab.
On discharge, make sure the Current Prescription(s)/Home Mediations accurately reflect the medications the patient should be taking at home.