Medication Reconciliation: Entropy v. Order

A few weeks ago, the Depart Process was rolled out across the three Baystate hospitals.  The "depart" is basically a revamping of the discharge process that accounts for all pieces of information that need to be shared with the patient or transmitted to the patient's next care provider at the time of discharge.  This new method is comprised of a variety of tasks, but the most fundamental is one that has always been part of medical practice: Medication Reconciliation.  

When challenged about the importance or ownership of med rec, I've always responded that this is one of the cornerstones of being a good doc.  How can I provide even adequate care if I don't ask, record and reconcile what medications my patient is taking?  

So what is med rec?  It's a rather straightforward process that makes patient care more efficient:

1. At the time of encounter, whether the office or the hospital, review the list of current medications in the EMR and by asking your patient.
• REMOVE any medications no longer taken using Cancel/DC in the medication list or Do Not Continue in the Med Rec tool.
2. Document those medications, vitamins, supplements that the patient reports as active but not previously prescribed or documented.
3. Determine what new medications required for treatment of your patient, whether in the hospital or in the office, and prescribe accordingly.
4. Review the list and provide a copy to your patient, or enter orders per routine.

NB:  If the patient isn't taking the medication, then the medication does not belong on the list.  Do not hesitate to remove (unless these are protocol meds, e.g. chemotherapy cycles)

Next post: a pictorial review of hospital-based med rec