The Medication Reconciliation Process

Background

The medication reconciliation process compares the medications taken by a patient prior to admission to a facility with the medication orders at the facility. The Joint Commission (TJC), the accrediting body for health care organizations, stipulates that the medication reconciliation process must be completed with 24 hours of admission (Sentinel Event Alert, Issue 35, 2006). This process begins with compiling an accurate list of the patient's home medications which are also referred to as prior to admission (PTA) medications. At UCHealth North, it is the job of the Pharmacy Admission Specialist (PAS) to compile and verify this list. The PAS must collect, record and communicate to the provider an accurate list of the patient's PTA medication using every means possible.

Problem Description

Some Pharmacy Admission Specialist (PAS) have difficulty thinking through what must be done when problems are presented in different contexts. Not only must the PAS interview the patient, verify the information and update the EHR, but the PAS must also determine where to find the information, how much time to devote to finding any single piece of verification, how to input the medication so that it is accurate and clear to the provider and pharmacist, and when to mark the list as "ready for provider" or leave it to be finished the next day with clear indication of what has already been completed. The standard work and practice is continually evolving to meet the demands of patient safety. This complex problem requires critical thinking skills with the ability to use the knowledge acquired in each scenario.

Instructional Context

UCHealth North is a region within University of Colorado Health, a health care system serving th...

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