MEDICATION

RECONCILIATION

By: Stephanie Samonte, RPh.

WHAT IS MEDRECON
PURPOSE

SOURCE: FIP MEDICATION RECONCILIATION

TOOLKIT 2021, COOPERATIVE OF AMERICAN
PHYSICIANS
POLICY
REQUIRED ORGANIZATIONAL PROCESS OF ACCREDITATION
CANADA INTERNATIONAL
 CLINICAL STEPS FOR
IMPLEMENTATION
Upon admission, obtain the complete list of medications the patient
is taking (or should be taking) prior to admission (e.g. the patient's
"medication history"). This list should be obtained from the patient,
whenever possible, although other resources (e.g. family,
caregivers, community pharmacies, past medical records, primary
care physician) may need to be contacted as needed. This list
should be documented in a single location within the medical record
that is utilized and is accessible to all healthcare providers.

IMPORTANT NOTES:

The medrecon form would serve as documentation of the process

Medrecon process is completed within 24 hours of patient
admission

Complete signatories for audit
 BEST POSSIBLE MEDICATION HISTORY

IMPORTANT NOTES:
The best possible medication history (BPMH) is an accurate, up-to-date and
complete medication history that compiles information on all prescription and
non-prescription medicines used by the patient, including the dose, frequency,
formulation and route of administration. The medicines information should also
include any herbal medicines, supplements, vitamins and other
alternative/complementary therapy the patient might
be taking.
ROLES AND RESPONSIBILITIES
 IMPLEMENTING TIMELINE
CORE OBJECTIVES PERSON TIMELINE ACTION PLAN RESOURCES STATUS
ELEMENTS RESPONSIBLE

1. Leadership Establish 3 core groups in the Nursing November 2022- Conduct a ACI ROP DONE
implementation of the policy Pharmacy onwards coordination Handbook and
a. Leadership team Physician meeting to AHRQ MATCH
- provides oversight for the medication Medication determine the toolkit for
reconciliation Reconciliation members of the medication
project. Committee different teams reconciliation
-Member(s) of the senior management P&TC
team (e.g., physician, nursing, and QMD
executive leaders in
the organization)
b. Design team
- play an integral role in the
development or redesign of the
medication reconciliation process.
-Physicians, nurses, pharmacists,
discharge planners, and others
representing areas of focus (e.g.,
inpatient units, outpatient clinics,
procedural areas)
-Representatives from information
systems, the emergency department,
and patient safety and
quality departments
c. Additional stakeholders
- provide facility wide support
- Department chiefs, chairs, and
clinical program leaders
2. Policy, Re-implementation of the medication Nursing November 2022 Hospital-wide Medication ONGOING
Guideline and reconciliation policy focusing on admission. Pharmacy Emergency Room and Implementation Reconciliation Form
Clinical Physician one patient care area
Pathways Medication (Station 1) ACI major compliance
Reconciliation requirement
Committee Hospital-wide NOT DONE
P&TC implementation 1st
QMD quarter of 2023

3. Best Possible Generate a comprehensive list of all medications Nursing September 2021 Creating Medication ACI ROP Handbook DONE
Medication the client is taking prior to admission (BPMH) Pharmacy Reconciliation Form and AHRQ MATCH
History for all admitted patients. The team uses the Physician toolkit for medication
(BPMH) reconciled admission orders to generate a Medication reconciliation
Practice current medication list that is kept in the Reconciliation
patient’s chart. Committee JCI Guidelines
P&TC
QMD
November – Started to use the Med- Medication DONE
December 2021 Recon form Reconciliation Form

Hospital-wide Assigned pharmacist Medication NOT DONE

implementation 1st on duty in the Pilot Reconciliation Form
quarter of 2023 area to facilitate
compliance to policy

November 2022 Assign a pharmacist on Company Laptop for NOT DONE

Emergency Room, one duty at the emergency pharmacist
patient care area room in order to ACI major compliance
(Station 1) facilitate compliance to requirement
policy
4. Pilot Generate a comprehensive list of all Nursing November 2021- Pilot Medication DONE
testing medications the client is taking prior to Pharmacy June 2022 implementation: Reconciliation Form
admission (BPMH) for all admitted Physician
patients. The team uses the reconciled Medication Emergency Room ACI major
admission orders to generate a current Reconciliation Station 1 compliance
medication list that is kept in the patient’s Committee requirement
chart. P&TC
QMD

5. Transition The BPMH will be part of the patient’s Nursing January to June Pilot Medication NOT DONE
of care chart and would serve as a reference for Pharmacy 2023 implementation: Reconciliation Form
reconciling medication during transitions Physician (Station 1)
of care. Any changes to the patient’s Medication Emergency Room ACI major
medication therapy is documented (e.g. Reconciliation Station 1 compliance
medication is discontinued, added, Committee requirement
altered, or changed during a physician P&TC
visit, prescriptions completed during QMD
treatment.)

6. Discharge The team provides the patient and the Nursing Pilot Medication NOT DONE
Reconciliatio next care provider with a complete list of Pharmacy implementation: Reconciliation Form
n medications the patient should be taking Physician
following the end of service (Home Medication Station 1 Home Instruction
Instruction) and this list should be Reconciliation Form
reconciled prior to patient discharge. Committee
P&TC ACI major
QMD compliance
requirement
7. Education Multidisciplinary training for all Nursing January 2023- Hospital-wide Staff Assign one training NOT DONE
disciplines involved Pharmacy onwards Education: supervisor
Physician
Design a training curriculum to be Medication Old and Newly hire ACI ROP Handbook
followed Reconciliation Quarterly training and AHRQ MATCH
Committee for new staff toolkit for
P&TC medication
QMD reconciliation

8. Assessment System tracer is implemented Nursing Quarterly Report Submission of Audit Form On going
and Process Pharmacy Quarterly Report
Evaluation Use of metrics and auditing tools Physician TQD will conduct ACI ROP Handbook
Medication system tracers twice and AHRQ MATCH
Reconciliation a week to monitor toolkit for
Committee and evaluate the medication
P&TC program’s reconciliation
QMD implementation
and effectiveness.
ADDITIONAL REMINDERS:

IT IS CURRENTLY DESIGNING AN
APP FOR MEDICATIONS THAT
SHOULD NOT BE CRUSHED.
RESOURCES:

ACCREDITATION CANADA INTERNATIONAL 2015

MEDICATIONS AT TRANSITIONS AND CLINICAL HANDOFFS (MATCH)
TOOLKIT FOR MEDICATION RECONCILIATION
MEDICATION RECONCILIATION TOOLKIT – FIP 2021