Admission Medication Reconciliation Process Best Possible Medication History

Admission Medication Reconciliation Process Best Possible Medication History Completed by Utilizing Secondary Source Abiy Getahun, pharm. D

Multidisciplinary Team Approach

Admission Medication Reconciliation Process • Review Admission Medication History completed by Non-pharmacy personnel • For patients transferred from ER to the floor • Resolve medication history discrepancies by • Interviewing patient • Utilizing secondary sources – External. Rx, Call patient’s out patient pharmacy, check medication vials or interview family members • Communicate discrepancies with Patient’s Physicians

Patient Sample A

Admission Medication History With Discrepancies Omitted freq and route of admin

Secondary Source (External. Rx) Utilized to Resolve Discrepancies

Completed Admission Medication History Corrected freq and route

Patient Sample B

Admission Medication History with Discrepancies Incorrect dose Incorrect freq

Patient B Interviewed by Pharmacist • What Prescribe medications do you take at home ? • Verapamil once a day – Patient unsure of dose • Trazodone 200 mg po qhs – Omitted from the list • Migraine medication • What OTC mediations do you take at home ? – Pain control, Vitamins or Herbal products • Which Pharmacy do you use to pick up your medications? Secondary source • Walgreen • Admission Medication History Completed by calling out patient pharmacy

Completed Admission Medication History Omitted med added Corrected dose, freq and formulation