36C25819R0003-024.pdf

Phoenix VA Health Care System Phoenix, Arizona

Policy Memorandum No. 119- 20 April 12, 2018

MEDICATION RECONCILIATION

1. PURPOSE: To establish a consistent process to reconcile medications accurately across the continuum of care within the Phoenix VA Health Care System (PVAHCS) and its Community Based Outpatient Clinics (CBOCs).

The goal of Medication reconciliation is to maintain and to communicate accurate patient medication information. The process entails identifying, addressing, and documenting medication discrepancies found in the VA electronic medical record as compared with the medication information supplied by the patient. This information, along with any changes made during the episode of care, should be communicated to the patient, caregiver or family member, and appropriate members of the health care team.

Effective medication information management assists the health care team in identifying the patient's most effective treatment plan based on accurate patient medication information which in turn helps to mitigate the risk potential for adverse drug events (ADEs).

2. DEFINITIONS:

a. Medication reconciliation. Medication reconciliation is a process to ensure maintenance of accurate, safe, effective, and patient centered medication information by:

1) Obtaining medication information from the patient, caregiver, or family members.

2) Identifying and addressing medication discrepancies by comparing the information obtained from the patient, caregiver, or family member to the medication information available in the VA electronic medical record, including active medications, recently expired medications, medications given at other VA facilities (via remote data view), and non-VA medications.

3) Assembling and documenting the medication information in the VA electronic medical record .

4) Communicating with and providing education to the patient, caregiver, or family members regarding updated medication information.

5) Communicating relevant medication information to and between the veteran patients' health care provider teams.

Policy Memorandum No. 119- 20 April 12, 2018

b. Medication. Includes those prescription medications or diagnostic agents prescribed for a patient by a VA or non-VA provider; over-the-counter medications;

herbals; nutraceuticals; supplements; vitamins; and other holistic health care agents.

Includes scheduled and as needed (PRN) medications.

c. Medication Discrepancy. Medication discrepancies are unintentional differences found in the patient's medication information when compared to the medication information available on the electronic health record. These discrepancies may be omissions, commissions, inappropriate duplications, changes, and/or additions. These discrepancies may be generated from the patient or the health care system.

d. Medication List. The Med Form is a computer-generated medication list for distribution to patients, caregivers and/or family members. At a minimum, the Med Form shall contain drug name, strength , dose, route and administration instructions.

e. Non-VA Medications. Non-VA medications are non-VA prescriptions that are filled at non-VA pharmacies; VA provider prescribed medications that are filled at non-VA pharmacies; herbals; over-the-counter medications; nutraceuticals; and alternative medications. Non-VA medications include those medications that may be administered as scheduled or as needed (PRN).

f. VA Providers. VA providers are physicians, medical trainees, advance practice nurses, physician assistants, and other health care professionals who provide primary care or specialty care within the limitations of their individual VA privi leges or scopes of practice.

g. Adverse Drug Event (ADE). An ADE is an injury from the use of a drug. Under this definition, the term ADE includes harm caused by the drug (adverse drug reactions and overdoses) and harm from the use of the drug including dose reductions and discontinuation of drug therapy.

3. POLICY: It is the policy of PVAHCS to support a system-wide approach for the maintenance and communication of accurate patient medication information across the continuum of care.

4. PROCEDURES:

a. General procedural statements: Within the PVAHCS and CBOCs, it is the intent of the organization to involve patients in the creation of a complete medication list fo r the patient upon admission or entry into the system. If the patient is not capable of participating in this process, every effort should be made to obtain an accurate medication list from an attending caregiver and/or family member.

Medications ordered for the patient while under the care of the organization shall be

Policy Memorandum No. 119- 20 April 12, 2018 reconciled , with any discrepancies (e.g., omission, duplications, potential interactions and tt,erapy compl iance issues) being addressed. The patient should receive an updated medication list upon exit from the PVAHCS an<il CBOCs whenever medication therapy has been changed .

b. General Documentation Requirements:

1) Medication information obtained from a patient (or family member/care giver) at the episode of care must be reflected in the VA's electronic medical record , Computerized Patient Record System (CPRS).

2) Comparison of information provided by the patient (or family member/care giver) to the patient's CPRS medical information must be completed; such as medication discrepancies that were identified and their subsequent resolution.

3) Final updated medication list that highlights the added , changed and discontinued medications.

4) Discharge instructions provided at the end of the episode of care that are consistent with the final discharge medication information in CPRS.

c. Provider Resources: Health-system pharmacists and electronic medical information shall be available to assist providers with medication-related questions.

d. Patient Resources: A patient brochure shall be available to assist the patient in better understanding the importance of keeping an up-to-date list of medications, and sharing that list with each of their personal providers.

5. RESPONSIBILITIES:

a. The Medical Center Director, or designee, is responsible for:

1) Assigning a PVAHCS Medication Reconciliation Point-of-Contact.

2) Ensuring that this policy meets the intent of the VHA Directive 2011-012 Medication Reconciliation.

b. The Chief of Staff ensures that the medication reconciliation processes are standardized , and maintained throughout the PVAHCS and CBOCs, and in conformity with the most recent revision of the VHA National Dual Care Policy (VHA Directive 2009-038), when applicable in relation to non-VA providers.

c. Service Chiefs and supervisors are responsible for implementing this policy and educating staff about this pol icy.

d. The PVAHCS Provider is responsible for:

Policy Memorandum No. 119- 20 April 12, 2018

1) Completing Medication Reconciliation in accordance with this policy.

2) Documenting a plan to address medication discrepancies that is commensurate with the severity of the discrepancy and the risk of patient harm.

NOTE: Addressing a discrepancy does not always require a revision in the medication order.

3) Educating patients identified as dual care users as per VHA's National Dual Care Policy.

4) Documenting and reporting adverse events.

5) Assisting the Veteran patient, caregiver, or family member to maintain, update, and take ownership of the patient's medication information.

e. Other Health Care Team Members are responsible for:

1) Pharmacists shall review and address medication therapy discrepancies as a component of medication order verification.

2) Nurses shall immediately notify the patient's provider and pharmacist (verbally or through CPRS medical record documentation) of any medication reconciliation issues that may be identified through communication with the patient, the patient's caregiver and/or the patient's family.

3) The Veteran patient, caregiver and/or family member take ownership of the patient's medications and are encouraged and expected to be active participants.

Note: Although this policy identifies the patient's provider as the primary health care team member for ensuring medication reconciliation, the reconciliation process is in fact a shared and collaborative responsibility between providers, pharmacists, nurses, patients, caregivers and/or family members. All parties should assist to help ensure complete and accurate medication lists and medication therapy reconciliation.

6. RESPONSIBLE BOARD: Pharmacy and Therapeutics Committee/Clinical Executive Board

7. REFERENCES:

a) The Joint Commission Comprehensive Accreditation Manual for Hospitals, Medication Management, current edition.

Policy Memorandum No. 119- 20 April 12, 2018

b) VHA Directive 2009-038, VHA National Dual Care Policy, dated August 25, 2009.

c) VHA Directive 2011-012, Medication Reconciliation, dated March 9, 2011 .

8. RESCISSION: Policy Memorandum 119-20 dated July 8, 2014

9. ATTACHMENTS: None

10. FOLLOW-UP RESPONSIBILITY: Chief of Pharmacy

11. EXPIRATION DATE: April 2021

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RIMAANN 0. NELSON

Medical Center Director