Med recs

Half of med errors accounted for by

inaccurate/incomplete med recs

Med recs should be completed during

• admission

• transfer

• discharge

Med Recs can be completed by

• pharmacists

• interns

• techs

• other healthcare professionals

• only physician and pharmacist can resolve discrepancies

• patient is integral

Med Rec Process (TJC)

1. Med history (2+ sources preferred)

2. develop list of meds that are prescribed/planned

3. compare 2 lists

4. make clinical decisions based on comparison

5. communicate new med list to pt/caregivers/providers using SBAR

Med Recs important to identify

• duplicates

• interactions

• missing indications

• alternatives

Discrepancies to look for wheh comparing lists

• duplications

• omissions

• interactions

• appropriateness/need to continue/hold

Limitations of EHR

• lack of continuous communication across heatlh systems/funtionality to perform rec accurately

• records do not reflect actual patient use

Bronze level med rec

• best possible medication history with admission reconciliation

Silver

• best possible med history with admission rec

• rec at discharge by prescriber

Gold

• best possible med history with admission rec

• interprofessional discharge rec

• electronic discharge rx

Platinum

• best possible med history with admission rec

• interprofessional discharge rec

• electronic discharge rx

• attention to broader med issues (appropriateness)

Diamond

• best possible. medhistory with admission rec

• interprofessional discharge rec

• electronic discharge rx

• attention to broader med issues

• pharmacist-led counseling prior to discharge

• communicating med changes to community pharmacy

• post-discharge follow up phone call to pt