Admission Medication Reconciliation Process

1. Admission Medication Reconciliation Process Best Possible Medication History Completed by Utilizing Secondary Source AbiyGetahun, pharmD

2. Multidisciplinary Team Approach

3. Admission Medication Reconciliation Process • Review Admission Medication History completed by Non-pharmacy personnel • For patients transferred from ER to the floor • Resolve medication history discrepancies by - • Interviewing patient • Utilizing secondary sources – ExternalRx, Call patient’s out patient pharmacy, check medication vials or interview family members • Communicate discrepancies with Patient’s Physicians

4. Patient Sample A

5. Admission Medication History With Discrepancies Omitted freq and route of admin Omitted freq and route of admin Omitted freq and route of admin

6. Secondary Source (ExternalRx) Utilized to Resolve Discrepancies

7. Completed Admission Medication History Corrected freq and route Corrected freq and route

8. Patient Sample B

9. Admission Medication History with Discrepancies Incorrect dose Incorrect freq

10. Patient B Interviewed by Pharmacist • What Prescribe medications do you take at home ? • Verapamil once a day – Patient unsure of dose • Trazodone 200 mg poqhs – Omitted from the list • Migraine medication • What OTC mediations do you take at home ? – Pain control, Vitamins or Herbal products • Which Pharmacy do you use to pick up your medications? Secondary source • Walgreen • Admission Medication History Completed by calling out patient pharmacy

11. Completed Admission Medication History Omitted med added Corrected dose Omitted med added Corrected dose, freq and formulation