Medication Reconciliation Overview
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Medication Reconciliation Overview

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Questions and Answers

Which option should be selected in the Medication Orders column for the esomeprazole order if the patient is not currently taking it?

  • Unable to verify
  • No longer taking (correct)
  • Taking differently (specify)
  • Per PharmaNet

    • What would be an appropriate entry in the 'Verified with' column for salbutamol if the patient specifies using it as needed?

  • Taking differently (specify): Salbutamol 3 puffs per day
  • Taking differently (specify): Salbutamol 2 puffs as needed (correct)
  • No longer taking
  • Unable to verify

    • If the verification indicates that a patient is taking salbutamol 1 puff 4 times a day, which option is correct for the Verified with column?

  • No longer taking
  • Unable to verify
  • Per PharmaNet
  • Taking differently (specify): Salbutamol 1 puff 4 times a day (correct)

    • What does selecting 'Per PharmaNet' imply in the context of a medication order?

    <p>The patient's medication usage is confirmed through PharmaNet records</p> Signup and view all the answers

    In the circumstance where medication intake cannot be verified, what option would be the most appropriate?

    <p>Unable to verify</p> Signup and view all the answers

    What is the primary purpose of Medication Reconciliation in a hospital setting?

    <p>To enable prescribers to make informed prescribing decisions</p> Signup and view all the answers

    What does BMPH stand for in the context of Medication Reconciliation?

    <p>Best Possible Medication History</p> Signup and view all the answers

    Which of the following is NOT a component of the Admission Medication Reconciliation process?

    <p>Reviewing the patient's vital signs</p> Signup and view all the answers

    Which of the following best describes what is involved in the BPMH interview process?

    <p>Using a systematic process that includes patient/family interviewing and reviewing additional sources</p> Signup and view all the answers

    Why is pharmacy involvement critical in the Medication Reconciliation process?

    <p>Pharmacists are trained to verify community pharmacy records and medication histories</p> Signup and view all the answers

    In the evidence supporting pharmacy involvement in Medication Reconciliation, what was a key finding from the study conducted between January and April 2007?

    <p>It demonstrated that pharmacists conducted medication history for a substantial number of patients</p> Signup and view all the answers

    What is one of the outcomes of proper Medication Reconciliation during transitions of care?

    <p>Improved patient compliance with medication</p> Signup and view all the answers

    What key factor must be ensured before medications are added, changed, or discontinued during Medication Reconciliation?

    <p>Careful evaluation must be conducted</p> Signup and view all the answers

    What percentage of medication histories contained at least one medication discrepancy?

    <p>98.5%</p> Signup and view all the answers

    In the prospective study, what percentage of patients had adverse drug events identified by pharmacists?

    <p>35.6%</p> Signup and view all the answers

    What was the overall relative reduction in the number of days patients were admitted to the hospital when pharmacists led the medication review?

    <p>8%</p> Signup and view all the answers

    Which of the following was identified as a source for gathering medication information?

    <p>Medication adherence aids</p> Signup and view all the answers

    What level of medication history discrepancies did student pharmacists identify?

    <p>96%</p> Signup and view all the answers

    What was a notable finding regarding the control group in the student pharmacist study?

    <p>More ED visits within 30 days after discharge</p> Signup and view all the answers

    What percentage of significant errors were categorized as serious or life-threatening?

    <p>68%</p> Signup and view all the answers

    Which type of information should be reconciled with the BPMH process?

    <p>Medications from any source</p> Signup and view all the answers

    During an interview for medication reconciliation, what should be verified about the medication vials?

    <p>The expiration date on the vial</p> Signup and view all the answers

    What practice is recommended to resolve discrepancies found in a patient's medication history?

    <p>Consult a pharmacist</p> Signup and view all the answers

    Which criteria would NOT be a consideration when reviewing MARs?

    <p>Patient's last meal</p> Signup and view all the answers

    How many interventions did pharmacists make in the retrospective study?

    <p>235</p> Signup and view all the answers

    What is an important factor when gathering information about a patient's own medication list?

    <p>Who wrote the list</p> Signup and view all the answers

    What intervention was done by pharmacy technicians in the retrospective chart review?

    <p>Conducting initial medication histories</p> Signup and view all the answers

    Which medication was the patient switched to from ranitidine?

    <p>Omeprazole</p> Signup and view all the answers

    In the medication reconciliation order form, what action should be taken for ramipril if the patient’s history confirms it is the correct dosage?

    <p>Give as per verified history</p> Signup and view all the answers

    What is the prescribed dosage of Vancomycin for Jerry Black?

    <p>1000 mg IV q8h</p> Signup and view all the answers

    If a patient has decided to stop taking naproxen, what is the appropriate action on the medication order form?

    <p>Discontinue</p> Signup and view all the answers

    Which option would you select to indicate a patient has stopped taking esomeprazole?

    <p>No longer taking</p> Signup and view all the answers

    What information is needed to properly fill out the 'Verified with' column for medication reconciliation?

    <p>Patient's medication history</p> Signup and view all the answers

    Which column should be used to note changes to a medication order based on the patient's report?

    <p>Medication Orders</p> Signup and view all the answers

    What should you do if the patient's history contradicts the medication listed in PharmaNet?

    <p>Use the patient's history for reconciliation</p> Signup and view all the answers

    What is the main purpose of completing a medication reconciliation order form?

    <p>To ensure continuity and safety of medications</p> Signup and view all the answers

    Which medication is indicated for treating osteomyelitis in the case provided?

    <p>Vancomycin</p> Signup and view all the answers

    If the patient is taking a multivitamin daily, how should this be recorded on the medication reconciliation form?

    <p>As a prescription medication</p> Signup and view all the answers

    What is the appropriate action to take if a patient's medication history is unable to be verified?

    <p>Document as 'Unable to verify'</p> Signup and view all the answers

    When reconciling medications, what is the role of the clinical pharmacist?

    <p>Verifying and documenting the patient's medication</p> Signup and view all the answers

    In the context of medication reconciliation, what does 'DTP' stand for?

    <p>Drug Therapy Problem</p> Signup and view all the answers

    Study Notes

    Medication Reconciliation

    • Medication reconciliation is a process of ensuring that a hospitalized patient's medications are correct and safe for their current condition.
    • Medication reconciliation uses a Best Possible Medication History (BPMH).
    • BPMH involves a systematic process to interview the patient/family and the review of other reliable sources of information.
    • BPMH is performed at admission, transfer, and discharge.
    • Medication reconciliation helps healthcare providers make better prescribing decisions.

    Why Pharmacists Should Be Involved

    • Pharmacists and students can play a crucial role in medication reconciliation.
    • Studies have shown that pharmacists are more effective at identifying medication discrepancies than Registered Nurses (RN).
    • Pharmacist involvement can lead to a reduction in hospital stay duration.
    • Pharmacists can identify adverse drug events and help prevent medication errors.

    The BPMH Interview Process

    • Gather information from different sources.
    • The patient/family/caregiver should be interviewed.
    • Other sources like vials, blister packs/adherence aids, MARs, med calendars, community pharmacy, and Pharmanet should be consulted.
    • Information from different sources should be compared and differences resolved.
    • Information should be documented.

    Resources for Information

    • Medication vials: Check the date of the vial, the name on the vial, and whether the medication in the vial matches the label.
    • Blister packs: Check for updates since the last pack.
    • MARs: Different facilities have varying formats, be aware of the administration of doses, PRNs, doses held, and changes.
    • Patient's own med list: Check the date, last updated, and who wrote the list. Ensure all medications are included, including over-the-counter medications.

    Documentation

    • Documentation is crucial when completing a medication reconciliation form.
    • The medication history form should be completed with the date, time, interviewer's signature, and initials.
    • If discussed with the physician, a prescriber signature is required.

    Practice Case 1

    • A 28-year-old male admitted for cellulitis was taking clindamycin 300 mg po QID for 5 days prior to admission.
    • The ER MD started him on Cefazolin 1 g IV q8h.
    • He was also taking omeprazole 20 mg po daily PRN for reflux, even though his Pharmanet showed a prescription for 20 mg po daily.
    • The patient stated that he was taking ranitidine 150 mg po daily for reflux, but his Pharmanet showed a prescription for this medication.
    • The patient was also taking a multivitamin tablet po daily.

    Practice Case 2

    • Jerry Black was admitted for osteomyelitis and the ER clinical pharmacist was asked to complete a med rec order form.
    • The ER physician decided to start the patient on Vancomycin 1000 mg IV q8h x 8 weeks instead of cephalexin.
    • The patient was already taking multiple medications before admission.

    Practice Case 3

    • Heather Knox, a 93-year-old female, was admitted for a hip fracture and the ER clinical pharmacist was asked to complete a med rec order form.
    • She was taking ramipril 5mg po daily, naproxen EC 375mg po twice daily, esomeprazole 40 mg po daily, and salbutamol 2 puffs as needed.
    • The patient stated that she was no longer taking esomeprazole and that she was only taking salbutamol 2 puffs as needed.

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    Description

    This quiz explores the process of medication reconciliation, focusing on the Best Possible Medication History (BPMH) and the importance of pharmacists in this critical healthcare process. Understand how medication reconciliation can enhance patient safety and improve prescribing decisions during patient admissions, transfers, and discharges.

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