Transfer medication reconciliation process

[MunoRN, RN]

This is a side discussion in another thread, apparently it may be only the places I've worked that require a medication reconciliation when a patient transfers from one level of care to another (such as when a patient is transferred from med-surg to ICU, or vice versa).

In other words, are Doctors where you work required to review the patient's meds and indicate which meds they want continued after transfer, and those not continued are then D/C'd?

Do all orders carry over automatically? Do any orders carry over?

[Nurse Kyles, BSN, RN]

We do have a med rec when a patient goes to surgery. We used to print out all the pre-op meds and treatments and the doc would circle which ones they wanted to continue after surgery. I am not really sure how it works now that we are "paperless". I think we just put the medications in the computer as "hold". The doctor will then reevaluate the meds and use the post-op order set in the computer. For our CABG patients, the order set includes canceling CCU orders when the patient comes to PCU. I do know that we do not do a med rec for example if the patient transfers from a med-surg unit to PCU for a drip. All the other orders carry over from med-surg.

[Catzilla]

MunoRN,

Like yours, my facility requires med rec whenever patients are transferred to another unit.

I believe that this practice was a recommendation put out by the Institute of Medicine- one that TJC really embraced.

[Catzilla]

Whoops- double post

[blondy2061h, MSN, RN]

It used to be all meds were d/c'ed when a patient moved in or out of ICU and had to be reordered. A lot of meds were getting missed and never reordered, so they stopped that. Then we had the opposite problem. Patients were being transferred to med surg with drips ordered they couldn't do. We never have enough ICU beds, so they're frequently trying to push patients out. Now the meds are kept ordered but the manager looks at the MAR to make sure all the meds are appropriate for that unit. I like the idea of a simple check list for meds to be continued.

[turnforthenurse, MSN, NP]

The meds are only reconciled when the patient first gets admitted. If they are transferred, the reconciliation isn't done again - the MD just discontinues whatever medications the patient does not need to be on and it also depends on the level of care. Obviously if a patient is being transferred to med surg, they are no longer going to have that dopamine drip ordered.

[guest2210]

It depends on whether your facility has an EMR program or not. Some of the EMR programs require med recs upon transferring from one unit to another. If the facility has Epic, the docs are required to complete the med rec from one unit to another before that patient can be moved to that bed. Some facilities give the RNs this task. But most facilities I've been in, it is the docs responsibility.

[psu_213, BSN, RN]

The hospital for which I used to work required med rec be done after after each procedure and with each transfer to a different "type" of unit (for example ICU to telemetry floor, etc.).