Medication Reconciliation

[HeaFea]

I am just starting in this field and I am kind of confused when it comes to reconciling meds. What exactly is med reconciliation? It is the meds that the next pt has, that don't match my list? Or vice versa? The program has a section for "list of meds to be reconciled" and im not sure what I am suppose to put there.

[merlee]

Weren't you given an orientation? Ask your preceptor how it is done at your facility. There are many different ways - you need to find out how it is done at YOUR facility.

Generally, you are matching up what is actually ordered with what is on hand for that patient.

Look in your procedure manual.

[tokmom, BSN, RN]

For our facility, it's taking the pt's home meds and putting them in the computer and the times last taken. On dc, we take the same list and use the dc med orders and make a complete med list.

You need to look at your facility PnP

[HeaFea]

Thank you! Ill do that.

[NRSKarenRN, BSN, RN]

Thread is in the Home Health Forum, so you need to look at your home health agency procedure manual and confirm with your educator/ supervising RN how they want the form completed.

Med reconciliation is HUGE in home health and needs to be part of every nursing visit.

Some agency's want every med reconciled at admission visit: check all meds in home against meds listed on facility discharge sheet or referring doctors orders...( If you can find the patients discharge papers . Clients who didn't get prescriptions filled (not on insurance drug formulary, can't afford, daughter has orders RX's etc) need to be revisited next day or at least called. Remember all meds taken by the patient including over-the-counter (OTC), laxatives, allergy, vitamins and herbal's need orders for home care.

Here's the process I've used with success:

Prior to the Admission visit:

Call the patient to inform of visit time. Tell them to gather together

a. Insurance cards ( type insurance influences medication payment, along with home care payment.)

b. Discharge instructions/dcotors orders.

c. Any and all medications they take including over the counter.

Admission visit:

a. Confirm insurance policies against referral information; inform office if different.

b. Review discharge summary for medication list /review unfilled prescriptions=Rx's in home.

c. Inventory all medications + over the counter and herbal meds in home.

d. Compare inventory against discharge medication instruction especially looking for:

same med (brand + generic version), dosage changes, expired medications, drug-drug interactions

e. Discrepancies: Call referring physician; can't get hold doctor, call referral source --even intake or nursing supervisor if unable to contact referring doctor = attending doctor.

Contact primary care provider (PCP) when warranted, especially when seen in teaching clinics, ER referral to confirm meds and obtain medication orders.

Some agencies have policies that staff contact PCP and get all orders from them as they have almost 100% success in getting homecare orders signed and returned to agency. Is admission staff RN responsible for this or office based Supervisor/ Clinical Mgr--know your agency policy.

f. Discuss with patient how meds currently managed: is client, spouse/ significant other, son/daughter, neighbor helping them with med administration. Is envelopes, prefilled med box, or pharmacy prepared blister packs indicated

g.. Review meds with patient/others involved and discard expired meds. Leave written med list with doses, amount pills, med times and reason for taking in the home. Begin med teaching.

h. Financial issues with obtaining meds or med not on formulary (consult with Pharmacist re which med may be covered): inform prescribing doctor/PCP if. Ask prescriber/PCP has samples available. Ask for Medical Social Work (MSW) eval for financial counseling, assistance getting enrolled in free drug programs.

Some medicaid programs won't cover MSW so RN's do leg work.

i. Is client on meds that need periodic lab work for therapeutic monitoring--arrange as indicated. Note in chart lab patient is going to, practitioner who will be monitoring meds: phone + fax #, versus agency to obtain labs and report to prescriber.

2nd visit to home:

a. Confirm that all meds are present in home against written orders.

Look for discrepancies, OTC meds not present on first visit.

b. Eval patients med compliance and understanding previous teaching.

c. Look for drug-drug and drug-food interactions and side effects.

d. Eval lab work as indicated.

e. Revise med list if changes.

f. Look for drug-drug and drug-food interactions and side effects.

g. Teach 1-2 meds.

All future visits:

a. Check written med list in home, compare to all meds, new RX's.

b. Eval med compliance --check pill box and pill containers periodically to see if properly being taken.

c. Eval comprehension of previous teaching

d. Look for drug-drug and drug-food interactions and side effects:

report to attending Dr/PCP, note in chart.

e. Eval lab work as indicated. Notify doctor immediately for any

abnormal results.

f. Revise med list if changes.

g, Report med non-compliance to attending doctor and supervisor and

# attempts to educate, consider change teaching strategy.

h. Continue teaching 1-2 meds, re-educate as needed.

i. If client confused/forgetful, make sure family member/emergency

contact notified issues with meds. Consider referral to office

aging/disability programs for long term medication management.

j. Update attending doctor re any above issues noted.

[caliotter3]

Thanks for this helpful post Karen. I have my first visit with a brand new client with nothing in place, so I plan on using the information in this post as a guideline for part of that visit. Good info right when I needed it!

[HeaFea]

Thank you! That was so helpful, especially since I am going to be doing admissions!

[NCIANurse]

Our Med Rec is done on admission, recert, DC, and when a new med is added. Ours is like this:

How we reconcilled (using hospital dc sheets, ect)

allergies

look alike sound alike (are they on metformin and metoprolol? how will they keep them straight?)

how meds are stored. (away from light, heat, moisture?)

high risk meds: coumadin, diabetic meds, etc. what teaching we've done to keep them safe, handouts given, etc.

oxygen: if on supplemental o2, has safety sheet been done? back up tanks stored appropriately?

duplicate medications

potential interactions between current meds

compliance of meds

effectiveness of meds

reported side effects