IMM 17: MTM in HP I Flashcards
What is medication reconciliation?
formal process in which the healthcare provider works together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care
- requires a systematic and comprehensive review of all the medications a patient is taking to ensure that medications being added, changed or discontinued are carefully evaluated
- component of medication management that will inform and enable prescribers to make the most appropriate prescribing decisions for the patient
What is a best possible medication history (BPMH)?
systematic process of interviewing the patient/family and reviewing at least one other reliable source of information to obtain and verify all of a patient’s medication use (prescribed and non-prescribed)
What is a best possible medication discharge plan?
comprehensive plan that accounts for the medications that the patient was taking prior to admission, the most current medication list, and any new medications planned to start upon discharge
- should result in avoidance of therapeutic duplications, omissions, unnecessary medications and confusion
- clarifies the medications the patient should be taking post-discharge by reviewing: medications the patient was taking prior to admission (BPMH), most current medication administration record (MAR) or medication profile, new medications planned to start upon discharge
What is a primary medication history?
medication history taken at time of admission using various sources of information, including patient/family interviews, review of medication lists/vials, or follow-up with community pharmacy or family physician
What is an intentional discrepancy?
prescriber has made a choice to add, change, or discontinue a medication and this has been clearly documented
What is an unintentional discrepancy?
potential medication error in which the prescriber change, added, or omitted a medication the patient was taking prior to admission
How can implementation of a proper MedRec system increase patient safety?
can prevent adverse events
- ensure that a patient has access to all the medications they take at home at all times
- ensure that any medication that is continued, discontinued or modified (ie. dose or frequency change) in the regimen is done with intent and proper documentation
What is a care transition?
transfer of a patient between different settings and health care providers during the course of an acute and chronic illness
What are the MedRec steps in acute care?
- create a complete and accurate BPMH of patient’s medications including name, dosage, route frequency
- interview patient and families
- conduct review of at least one other reliable source of information
- reconcile medications
- use BPMH to create admission orders or compare BPMH against admission, transfer, or discharge medication orders
- identify and resolve all differences or discrepancies
- document and communicate any resulting changes in medication orders to patient, family/caregiver, and next provider of care
What is e-MedRec?
use of electronic tools or health IT to perform medication reconciliation – uses information technology to access and integrate electronically stored patient medication data to support:
- collection of the electronic Best Possible Medication History (e-BPMH)
- detection and resolution of discrepancies
- comparison of e-BPMH and new orders at transfers
- development of an electronic Best Possible Medication Discharge Plan (e-BPMDP), including discharge prescription information that can be electronically transmitted to health information repositories
What are the 3 benefits of e-MedRec?
- integration – provides an enhanced ability to integrate with internal hospital systems (such as computerized provider order entry/CPOE) and external systems (such as provincial databases or drug information systems)
- effectiveness – some Canadian hospitals have shown e-MedRec is more effective than p-MedRec in integrating processes and facilitating discharge
- efficiency – can improve efficiency of MedRec processes by providing electronic tools to support clinical activities and enhance patient safety
What is an electronic medication administration record (e-MAR)?
electronic record of patient’s medication administration history
What is a decision support system (DSS)?
computerized system designed to support clinical decision making, including provision of educational resources and guidelines, as well as automated alerts and reminders for healthcare providers
What is a computerized provider order entry (CPOE)?
health IT that facilitates process of electronic order entry, allowing authorized healthcare providers to order medication, tests, and procedures, and provide other instructions pertaining to treatment of patients under their care
What is a drug information system (DIS)?
electronic repository of medication and prescription data that is held at a regional level – regional health authority or province (ie. PharmaNet in BC, Pharmaceutical Information Program in Saskatchewan)
