Medication Reconciliation

Bridging the Gap: Caring for the CognitivelyImpaired Elderly in the Home Care SettingMedicationReconciliationYurcania Villalona RN, MSN

Objectives• Demonstrate the process of medicationreconciliation• Define medication reconciliation• Demonstrate key interventions that facilitatethe medication reconciliation process• Identify the function of the home care teamin the process of medication reconciliationand administration• Identify the challenges of medicationadministration for the cognitively impaired2

Just a reminder…10 Medication Rights• Patient• Medication• Dose• Route• Time• Assessment• Patient Education• Documentation• Refuse• Evaluation3

Case Study• Meet Ms. Rodriguez76 old• Recently D/C fromhospital• Dx- UTI, DM, HTN,Parkinson’s, Obesity,Retinopathy andforgetfulness• Lives alone, hassupportive daughterin NJ that visits 1-2times every month4

Discharge Medications• Sinemet 25/100 po BID• Nicardipine 5 mg po OD• Hydralazine 2.5 mg po OD• Labetalol 5 mg po OD• Catapres 25 mg po OD• Cipro 100 mg po BID• Lantus 10 u, sq QAM• ASA 81 mg po OD• Trazodone 25 mg po HS5

Meds Discovered in the Home• Metformin 500 mg BID• Ambien 10 mg HS• Tylenol 350 mg 2 tabs q6h prn• Lipitor 20 mg OD• HCTZ 25 mg OD6

Information needed forMedication Reconciliation• What would beyour process?• How would youstart?• What may be someof the challenges?7

Medications to be Reconciled• Sinemet 25/100 BID• Nicardipine 5 mg OD• Hydralazine 2.5 mg OD• Labetalol 5 mg OD• Catapres 25 mg OD• Cipro 100 mg BID• Lantus 10 u, sq QAM• Metformin 500 mgBID• Ambien 10 mg HS• Tylenol 350 mg 2 tabsq6h prn• Lipitor 20 mg OD• HCTZ 25 mg OD• ASA 81 mg OD• Trazodone 25 mg HS8

What ismedicationreconciliation?

MedicationReconciliation• Medication Reconciliation is theprocess of creating the most accuratelist possible of all medications apatient is taking - including name,dosage, frequency and route -comparing that list against thephysician’s admission, transfer and ordischarge orders, with the goal ofproviding correct medication to thepatient.• 5 million lives Campaign. Getting Started Kit: Prevent Adverse DrugEvents (Medication Reconciliation) How to Guide. Cambridge, MA:Institute for Healthcare Improvement; 2008. (Available at www.ihi.org )10

Who is responsible?11

Why do we have to do it?• Adverse DrugEvents‣ Adverse DrugReactions (ADR)• Prevent medicationerrors• Assess adherenceto medicationregimes• Decreasedhospitalizations12

When and where doesreconciliation occur?13

4 Step Process ofMedication Reconciliation• Verification - collection of themedication history• Clarification - ensuring that themedications and doses are appropriate• Reconciliation - documentation ofchanges in the orders or reason forchanges• Transmit - communicate the updatedand verified list to appropriate parties14

What tools are available?• Medication list• Computerized DrugUtilization Review• Partnerships withcommunitypharmacies• Partnerships witharea hospitals15

Medication Administration:Challenges in the Home SettingMedication management is an ongoingprocess that is always being evaluated bythe clinician.• Can the patient manage to take the meds correctly?• Who is going to assist and supervise the cognitivelyimpaired patient?• Is it safe?• Who can help?• How many pharmacies are involved?• What is the plan?18

How are you goingto make thedifference?

Did we meet our Objectives?• Demonstrate the process of medicationreconciliation• Define medication reconciliation• Demonstrate key interventions that facilitatethe medication reconciliation process• Identify the function of the home care teamin the process of medication reconciliationand administration• Identify the challenges of medicationadministration for the cognitively impaired20

References• 5 million lives Campaign. Getting Started Kit: PreventAdverse Drug Events (Medication Reconciliation) How toGuide. Cambridge, MA: Institute for HealthcareImprovement; 2008. (Available at www.ihi.org )• Sensmeier, J. Clinical synergy yields safer care, betteroutcomes: The partnership between nurses and pharmacist isbound by the mutual commitment to patient safety. Nov.2007, Pharmacy Solutions.• http://www.ihi.org/NR/rdonlyres/50C10B25-BF43-46AE-93F2-865DAA1F9A9/2131/BMHMemphis_MedReconForm1.pdf• Powell, S. Safe transitions are a team sport. ProfessionalCase Management. 13(5):247-249. October 2008.• Ptasinski, C. Joint Commission Solutions. Develop amedication reconciliation process. 18-22 March 2007.21

10 minute breakPlease be mindful of the time.If we are late restarting, today’sschedule will be extended to complywith CEU and Contact Hourrequirements.22