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Using the CIS forMedication Reconciliation

Inpatient Providers

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• A Joint Commission Patient Safety Initiative with two goals:– Review patient’s current medications on:

• Admission (Entry to Children’s)• Transfer between levels of care and providers• Discharge (Exit from Children’s)

– Give a complete list of medications to be continued at home to the patient/family on discharge.

Medication Reconciliation

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Process OverviewAdmission/Transfer

Admission to Hospital– Medication Intake Coordinator (MIC) documents current home

medications in the CIS Medication Profile. If there are questions, Pharmacist reviews.

– Provider receives Medication Reconciliation alert after MIC documentation/Pharmacy review.

– Provider reviews home medications and signs the Medication Reconciliation form.

Transfer between Departments/Services– Provider receives Medication Reconciliation alert.– Provider reviews current and home medications then signs the

Medication Reconciliation form.

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Medication Reconciliation Worksheet for Admissions – Part 1

• Print the Medication Reconciliation Worksheet as a reference tool to assist you in: – Reviewing the patient’s home medications– entering the medication orders. (This is easier than toggling between

the Medication Profile and the Orders tab.)• To access the Medication Reconciliation Worksheet:

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Medication Reconciliation Worksheet for Admissions – Part 2

• Indicate on the worksheet which medications will be continued during the hospital stay.

• Open the CIS and complete the Provider Medication Reconciliation form. (described later)

• Order the patient’s medications in the CIS.• Give the worksheet to the admitting nurse so she/he can be aware of

which medications will not be given during the inpatient stay.

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Admission/Transfer

Medication Reconciliation AlertThe Medication Reconciliation alert displays when the Provider opens the patient chart after admission or transfer.

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Admission/Transfer

Step 1: Open the Form

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Admission/Transfer

Step 2: Complete the Form

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Admission/Transfer

Step 3: Sign or Close the Form

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Process OverviewDischarge

Discharge from Inpatient (Exit to Patient’s Home)– Provider receives Medication Reconciliation alert after

entering an EasyScript home medication or Discharge from Hospital stay order.

– Provider reviews patient’s medications for discharge and updates the Medication Profile.

– Provider signs the Medication Reconciliation form. – Nurse prints, reviews and gives the Discharge Home

Medication List to patient/family.

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Discharge

Medication Reconciliation AlertThe Medication Reconciliation alert displays when the

provider enters:• An EasyScript for discharge medications• The Discharge from Hospital Stay order

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Discharge

Step 1: Open the Form

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Discharge

Step 2: Complete the Form and Sign

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DischargeNurse Prepares the Discharge Home

Medication ListThe Nurse:

1. Prints the Discharge Home Medication List.

2. Reviews list and if any questions or concerns, asks the provider to address them.

3. Fills in times for Last Dose and Next Dose

4. Gives list to patient/family.

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Key Points

1. Review patient’s medications and complete the Medication Reconciliation Form at admission/transfer/discharge.

2. To access the Medication Reconciliation Form: click the Patient Care Activities tab, then the Med Rec sub tab.

3. On discharge, make sure the Current Prescription(s)/Home Mediations accurately reflect the medications the patient should be taking at home.