Medication reconciliation notes

Here are some tips for Medication reconciliation (med rec):

  • It is highly recommended that you complete Admission Med Recs before selecting any admission order sets. That way you will only have to reconcile the patient’s home meds if they have been entered into the system by the nurse or pharmacist. This would eliminate the frustrating need to reconcile meds added in the hospital. You should use the DEF tab to hold home meds you don’t want the patient to take until they go home. Likewise it is best to wait till the last step before discharge to make sure you capture all of the meds you want the patient to take at home, and don’t forget you have the tab bottom right of the med rec screen to add home meds.
  • Additions, deletions, or corrections that are done by any nurse or provider to the CPOE, after the discharge med rec was completed by clicking on the complete button, will negate the initial med rec. This will lead to the need to completely redo the discharge med rec. Therefore, please click on Save Draft unless you are certain the discharge med rec is complete.
  • If you have completed the med rec and have the checkered flag, you are done. If you have done that just once, it should cross to the nurses for their discharge instruction document.
  • If you have completed the med rec and have the checkered flag, and for some reason you receive in your action list a message to complete the med rec, please hit the reject button.
  • Surgeons, we have had complaints from primary physicians that have been assigned a post-op medication reconciliation. The post-op med rec should be under the purview of the surgeon. If the surgeon is uncomfortable with any particular med, please complete what you can and click “Save Draft”. Please notify the attending or primary to complete the remaining fields, but in most cases I would think it is simply renewing meds already given preoperatively. If you see obvious intraop or pacu type meds that shouldn’t be continued, please cancel these meds.
  • If the RN cannot she your completed med rec, ask him/her to check in Clinical Care Station under the Patient Profile icon and to click on the Printer icon where your medication reconciliation report will be viewable and printable by the nurse.
  • Please note that a Saved draft for Med Rec can’t be seen by a nurse.
  • Please note that until the Saved draft is ultimately completed by the responsible physician, patient throughput is stalled and discharges are delayed and admission or post-transfer meds will be delayed.
  • If you make any changes to the meds after you click the “Complete” button on the med rec, it will make you re-reconcile the meds. Unfortunately, if you change something as a result of an alert that you receive, it will make you redo the meds.