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Medication reconciliation is critical to prevent adverse drug reactions. Providers must reconcile medications for patient safety and minimize discrepancies. Learn the process and key actions needed for effective medication reconciliation.
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Ambulatory Medication Reconciliation Caroline Keogh, MS RN Patient Safety Center for Clinical Excellence Dermatology Clinical Faculty Meeting March 27, 2014
Meaningful Use NPSG ACO P4P Why is medication reconciliation important? • Intended to identify and resolve medication discrepancies • Standardized process of comparing a patient’s prescribed medications to those medications the patient is actually taking1 Medication reconciliation is critical to preventing adverse drug reactions which can lead to patient harm • The Joint Commission. Medication reconciliation sentinel event alert, Issue 35. 2006. Available at: http://www.jointcommission.org/sentinel_event_alert_ issue_35_using_medication_reconciliation_to_prevent_errors/
What do providers need to do? • Focus on visits with a medication change • Medication change: • addition of a new med • discontinuation of an existing med • change in the dose or frequency of an existing med • Reconcile medications which they prescribe • All medications on the medication list should be reviewed for drug-drug interactions • PCPs and Specialists have the same standard • Ideally, all meds should be assessed/ reconciled
BWH Ambulatory Med Rec Measurement • % of visits with a medication change where all medications originally prescribed by the provider are reconciled • Numerator: # of visits with 100% of the medications originally prescribed by the provider reconciled • Denominator: # of visits with a medication change
Sample Scenarios At every visit you should review the full medication list routinely to confirm that what you are prescribing does not interact with what the patient is already taking
A few examples… • Patient seen for an annual visit; patient is no longer taking Zofran • Med change = discontinue Zofran • 10 other medications on the med list • 7 originally prescribed by the provider (0 acted on) • 3 prescribed by others (0 acted on) • Needed to click Taking/Not Taking/Taking Differently/Discontinue/Edit/Renew on all 7 originally prescribed meds to get full credit for the visit • Patient seen for follow up visit; 2 new medications prescribed. Diltiazem had been prescribed in the past. • Med change = 2 new prescriptions • Diltiazem was the only other medication on the patient’s medication list prior to the new prescriptions, and was originally prescribed by the provider. • Was not reconciled during the visit • No credit for the visit (needed to click “Taking” to get full credit)
A few examples… • Patient seen for a follow up visit in Rheumatology • Med change = added Humira, edited dose of prednisone • Reconciliation actions = renewal of folic acid, methotrexate • No action was taken on rifampin or synthroid (both originally prescribed by the provider) No credit would be given for this visit due to the rifampin and synthroid.
Summary • Process of Med Rec required only for visits with a medication change • You are only responsible for Med Rec on what you prescribe • Practice-wide implementation of a standardized med rec process • LMR Med Rec module has been configured to help make this process easier • Patients are getting their current med lists through the VSR for MU • Practices can determine the specific roles of who will participate in the process of Med Rec • If all practices/ depts participate in the process of Med Rec, the lists will improve over time – this is the right thing to do for our patients
Will reconciliation information appear in my notes? Reconciliation actions will now appear next to each medication in the med list when the list is imported into your notes (when you type, not dictate). This feature needs to be enabled.
What about entering medications I did not originally prescribe? If a medication is entered using these fields in the Rx Pad, or edited by clicking these fields, the medication will appear in the “Prescribed by Others” sort
BWH Ambulatory Med Rec Measurement The following measure is available in Report Central: *A med change is defined as the addition of a new medication, a change in dose, frequency, strength or form of an existing medication, or discontinuation of an existing medication.
