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Medication Reconciliation: Spread to MSNU & 4 West Pre-Admit Clinic. Origins of Medication Reconciliation.
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[i] Whittington J, Cohen H. OSF healthcare’s journey in patient safety. Qual Manag Health Care 2004;13(1):53-59
[ii] Michels RD, Meisel S. Program using pharmacy technicians to obtain medication histories. Am J Health Syst Pharm 2003;60:1982-1986
Type O = No discrepancy
Type 1 = Intentional discrepancy
The physician has made an intentional choice to add, change or discontinue a medication and their choice is clearly documented.
*considered to be “best practice” in medication reconciliation
Type 2 = Undocumented Intentional discrepancy
The physician has made an intentional choice to add, change or discontinue a medication but their choice is not clearly documented.
* 25-75% of all discrepancies
Type 3 = Unintentional discrepancy
The physician has unintentionally changed, added or omitted a medication that the patient was taking prior to admission.
*potential to lead to ADEs
To prevent Adverse Drug Events by implementing medication reconciliation in hospitals across Canada.
To decrease undocumented intentional and unintentional discrepancies by reconciling all medications at all interfaces of care for all patients.
What is the aim?
What is the scope/ boundaries?
BPMH-History taker (can be Pharmacy/ Nursing/ Physicians)
*Signs record as the history taker.
*Ensure that there is an admission medication history order sheet completed first.
*The BMPH list then becomes the admission medication orders.
Receives medication reconciliation education andcollaborates with
team to provide the BPMH
Review medication history, participate in reconciliation and signs BPMH as orders
Participates in collection and reconciliation of BPMH on admission, as part of practice scope
Participates in reconciliation of
BPMH, identifies discrepancy types,
sends data to QIC
Facilitates and Supports Process
Ensure consistent/ accurate data is obtained
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