Academic Day Seminar #8: Medication Reconciliation

I haven’t had the opportunity to use the medication reconciliation form yet, but have incorporated getting the BPMHs into my patient interviews. Having the BPMH allows me to identify any discrepancies between the medications in hospital and medications PTA. In SMH, pharmacists are allowed to order medications that ensure continuity of care. However, on the med rec form, only prescribers are allowed to fill in the reconciliation column (medication orders) of the form. In my future rotations, when performing medication reconciliations, I will keep the following in mind:

  • Med Rec requires medication history (from patient, caregiver, GP, community pharmacists, etc) AND Pharmanet
  • 3 step process: Collection and Verification (= BPMH and chart review) and then Reconciliation
  • Ask questions about drugs not listed in P’net: antiretrovirals, non-rx, vitamins, samples, study drugs, recreational drugs, herbal/traditional remedies, medications from outside of province or internet
  • Ask questions about unique dosage forms: eye drops, inhalers, injections, patches, sprays
  • Use open-ended questions: “Tell me how you take this medication?”
    • This might be hard for patients to answer, especially if they rely on a blister pack. But, I think it is definitely a good question to ask and to also have the P’net on hand to help guide the patient
  • Assess adherence PTA: fill dates, quantities listed in P’net and inquire about discrepancies
  • Verify accuracy with TWO sources.
  • Discuss with medical team and document
  • Transfers: when transferring between different levels of care, from hospital to hospital, post-op
  • Watch out for: duplication between orders on MRO and between MRO and PPOs
  • Role of pharmacists in ensuring quality med recs – an empty med rec form with a signature by the prescriber is like a blank cheque (as other well-meaning HCPs can fill it out under their name)
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2 thoughts on “Academic Day Seminar #8: Medication Reconciliation

  1. When addressing adherence, i often ask “we all forget to take our medicines sometimes. How many times in a week would you forget to take your pills”….this opens up the conversation and helps you to identify barriers to adherence, including: dexterity (able to open a blister pack or child proof container), visual, literacy, cognitive, and medication-taking beliefs (eg. pill burden). From there you can work on resolving barriers to adherence.

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