Medication Reconciliation: Discharge Timeout Casey Mashl, Pharm.D Mitchell Chan, Pharm.D PGY1...
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Transcript of Medication Reconciliation: Discharge Timeout Casey Mashl, Pharm.D Mitchell Chan, Pharm.D PGY1...
Medication Reconciliation: Discharge Timeout
Casey Mashl, Pharm.DMitchell Chan, Pharm.D
PGY1 Residents
Overview• Medication reconciliation is a vital part of patient
care and safety• Maintains continuity of care• Ensures appropriate
continuation/discontinuation of medications at admission and discharge
• Discharge timeout process – Accountability– Continuity– Safety
What is Med Rec?
• Medication reconciliation is a process to determine what Rxs, OTCs, herbals/supplements a patient is currently on
• Why do we need to do this?– Continue regimen while in the hospital– Determine if any medications are contributing to
the patient’s condition• Possibly increase/decrease or discontinue meds
How is Med Rec Used?
• Physicians review med rec prior to entering admission orders– If med rec is entered incorrectly, inpatient
medications can be continued incorrectly and may lead to patient harm
– Inpatient and discharge medications are also chosen from the med rec
Importance
• An accurate med rec allows for a safe transition of care both into the hospital and discharge to home
• When we know exactly what the patient taking at home, it allows for the highest level of medication optimization
Medication Reconciliation• Performed by– Pharmacist– Pharmacist Interns
• Multi-step process1.Review home medication list & External med history2.Perform patient interview3.Submit correct med rec into EMR4.Compare home meds with inpatient meds5.Contact ordering physician or practitioner
Medication Reconciliation
• IMAGE OF BAD MED REC
Discount Double Check
Discharge Timeout= Discharge Double Check
• Estimate of 2 in 5 patients in the hospital has discrepancies in their medication reconciliation that a pharmacist can correct and intervene1
• 56% reduction in chart discrepancies at discharge2
• Multi-step– Nurse-nurse, nurse-pharmacist check
• Admission• Discharge
1. Bishop MA, Cohen BA, Billings LK, Thomas EV. Reducing errors through discharge medication reconciliation by pharmacy services. Am J Health Syst Pharm. 2015;72(17 Suppl 2):S120-6.
2. Ruggiero J, Smith J, Copeland J, Boxer B. Discharge Time Out: An Innovative Nurse-Driven Protocol for Medication Reconciliation. Medsurg Nurs. 2015;24(3):165-72.
Discharge Timeout Form
Conclusions
• Med rec is vital in maintaining continuity of care and patient safety
• Discharge time out process aims to reduce the number of chart discrepancies and negative medication-related patient outcomes
• South County Hospital Discharge Timeout update