Medication Reconciliation

Here is an example to explain the situation we face. 

Say, for instance, an elderly lady, who lives on her own, dials 911 because she has been feeling dizzy for the last 45 minutes, she is scared and not sure what is happening.  The ambulance comes and takes her to the emergency room.  She is dizzy, confused, alone and does not have a list of her medications in her wallet.  Once there, after 2 hours’ worth of tests, she is admitted to the intensive care unit because her heart shows abnormal symptoms. 

She has a primary physician, a cardiologist for her ongoing heart condition, and a rheumatologist for her arthritic condition.  At home she has 7 different medications she takes on a regular basis, 3 or 4 dietary supplements and 2 or 3 medications she takes for pain control.  She also uses 3 or 4 different over the counter treatments for her bowel control. 

She receives the bulk of her prescriptions through a mail-order pharmacy because her insurance company convinced her that she had to go mail order or face steep financial repercussions; however, she does not have any information with her about the mail order pharmacy.   She also receives some of her medications from a local corner drug store that delivers some of her over the counter items to her when she needs them.

So, while she is in the hospital, the Hospitalist will stabilize her on a medication regimen.  She will most likely be visited at least once by her primary care physician, and then be sent home with directions to follow-up with her cardiologist.

When discharged, she will have a list of medications she is to take.  What about all of the medications she already has at home.  Are the medications she is being discharged on the same as the medications she was taking, or are they different?  Maybe they are the same medication; however, just a different dose.  What about all of the dietary supplements and the over the counter bowel preparations? 

Please understand, this is an extreme example.  Most hospitals do have systems put in place to help with medication reconciliation.  Medication reconciliation is "the process of comparing a patients medication orders to all of the medications that the patient has been taking”. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner or level of care.


I have talked about this in the past, and I will definitely discuss it more in the future; who's responsibility is it to make sure my medications are in order?  For a simple solution on how to take charge of your own medication reconciliation, please review my previous blog on:


Thanks
Steve
www.AudibleRx.com

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