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Kathryn Montanya, PharmD Lu Ann Vis, RN Camille Robinson, RN Connie Giere, RN

Medication Reconciliation: Implementation of a Standardized Process in the Electronic Medical Record. Kathryn Montanya, PharmD Lu Ann Vis, RN Camille Robinson, RN Connie Giere, RN Sue Flores, RN Cindy Fellencer, RN Jeri Katsaros, RN Bridget Gaughan, RN

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Kathryn Montanya, PharmD Lu Ann Vis, RN Camille Robinson, RN Connie Giere, RN

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  1. Medication Reconciliation: Implementation of a Standardized Process in the Electronic Medical Record Kathryn Montanya, PharmD Lu Ann Vis, RN Camille Robinson, RN Connie Giere, RN Sue Flores, RN Cindy Fellencer, RN Jeri Katsaros, RN Bridget Gaughan, RN Pamela Malone, RN Martina Novotny, PharmD

  2. Project Aims • Design and implement a process to document an accurate list of the patient’s current medications upon entry into our organization. • This includes a process to compare, or reconcile the medications to be provided with those on the list. • Provide the list of medications to the patient and their next care provider.

  3. Standardized Process • Outpatient medication list is documented in EPIC • By admitting MD for inpatients • By RN or other caregiver for ambulatory • List is reviewed (reconciled) prior to new medications being ordered • By ordering MD for inpatients • Documentation required – EPIC alert • By MD during H&P approval in procedure areas • By MD in ambulatory

  4. Standardized Process • Updated list is provided to patient • MD creates list and RN reviews with patient at inpatient discharge • Procedure area staff provides list if meds are prescribed • Clinic staff provides list to all patients • Updated list is provided to the next caregiver • All LUHS providers have access through EPIC • For inpatients, Admitting identifies outside provider, Medical Records will mail the list • For ambulatory and procedure patients, the list is provided to outside providers via referral letters

  5. Current Goals • Increase the number of inpatients with an outpatient medication list documented in EPIC • Decrease the number of errors in outpatient medication lists • Increase the number of outpatient medication lists that have been “Reviewed” during current admission

  6. Future Goals • Increase number of patients discharged with accurate medication list. • Decrease number of RN and PharmD interventions required to correct medication lists. • Evaluate and improve the inpatient transfer process. • Develop ambulatory and procedure area process measures.

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