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medication reconciliation

Identifies indication for each medication. Indications: Goals: - insure patients are on right medications after going in or out of hospital, nursing home ... Legal: - required each time a patient transfers into or within or out of a healthcare facility (JCAHO) Clinical significance: - can reduce medication errors by 70% Management: - ask patient to bring in all medications, including - prescription medications - over-the-counter medications - supplements & herbal preparations - for prescription medications, determine whether the directions of the label match those in the patient's chart - ask patient how he/she is taking the medication - ask about medication adverse events - ask about other medications prescribed by other providers - evaluate indications for each - eliminate medications with duplicate therapeutic or pharmacologic properties - screen for drug-drug interactions & drug-disease interactions - eliminate unnecessary medications - consult with other providers as needed - simplify medication regimen - use fewest number of medications & doses/day - always preview any change with patient & caregiver - provide changes in writing Notes: - not always done correctly [2] - medication reconciliation by hospital pharmacists or pharmacy technicians similarly effective (& better than usual care) in cutting medication errors [4]

Related

medication compliance (taking medicine)

General

medication management

References

  1. Prescriber's Letter 13(5): 2006 Detail-Document#: 220513 (subscription needed) http://www.prescribersletter.com
  2. Ziaeian B et al. Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge. J Gen Intern Med 2012 Nov; 27:1513. PMID: 22798200
  3. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev. 2016 Feb 20;2:CD008986. Review. PMID: 26895968 - Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev. 2013 Feb 28;2:CD008986. Review. PMID: 23450593
  4. Pevnick JM, Nguyen C, Jackevicius CA, et al. Improving admission medication reconciliation with pharmacists or pharmacy technicians in the emergency department: a randomised controlled trial. BMJ Qual Saf. 2017 Oct 6; PMID: 28986515 https://psnet.ahrq.gov/resources/resource/31527
  5. Baughman AW, Triantafylidis LK, O'Neil N, et al Improving medication reconciliation with comprehensive evaluation at a Veterans Affairs skilled-nursing facility. Jt Comm J Qual Patient Saf. 2021 Jun 11;S1553-7250(21)00153-7. PMID: 34244044 https://www.sciencedirect.com/science/article/pii/S1553725021001537