Patient engagement
Encourage and offer tools to patients and caregivers to help them manage their medications. Knowledge is the best medicine is a program that helps people take control of their health and work with their prescriber and the rest of their healthcare team to manage their medicines safely and appropriately. This program is supported by leading health organizations (e.g. ISMP, CMA, CPhA, CNA). Their site offers a free downloadable electronic tool, MyMedRec , which allows patients and caregivers to have their medication record on their smartphone or tablet. The tool helps patients and caregivers compile a full list of their medications whether prescription, over-the-counter or natural health products and share the information with their health care team as they see fit. A printable version of the tool is also available here.
Use pre-printed forms
If patients do not have the medication information with them, give them a form to fill out in the ED to list their medications. Streamline the process by incorporating the medication history into existing forms such as order forms so that the reconciliation process can occur at the time of medication prescribing. Please see Appendix 3 for a sample form that can be used in the ED to collect the BPMH and conduct medication reconciliation.
Flag patients with missing medication information
Complete medication histories may be difficult to obtain for various reasons. The purpose of flagging patients with incomplete medication lists is to make it obvious to clinicians in the ED that a patient has missing medication information. Once a patient’s medication history is confirmed, medication reconciliation can occur and the flag can be removed.
Assign responsibility for each step of the medication reconciliation process
In many hospitals, especially those without ED pharmacists or pharmacy technicians, nurses are the main healthcare providers involved in gathering and documenting the BPMH. The reconciliation step can be completed by a physician or nurse practitioner when writing orders for the patient and at the patient’s discharge from the ED. The final step of communicating and documenting any medication changes can be a shared responsibility or delegated to the health care provider who last sees the patient prior to transfer of care.
Prioritize patients
If performing medication reconciliation for all patients in the ED is not feasible, start the process by prioritizing patients who may be at highest risk for adverse drug events. Patient factors such as older age, being on multiple medications, having multiple comorbidities, having had recent medication changes, and being on high-risk medications have all been associated with increased risk of adverse drug events (9). Identifying target groups who may benefit the most from medication reconciliation through use of a predetermined set of criteria or clinical decision rules can help focus the process.
The appendix is the Sinai Order Set which I sent on the Word document.
