D.20 36C26126R0014 Standard Work_Medication Reconciliation.pdf
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- Community Based Outpatient Clinic - Yreka, CA
- Solicitation number
- 36c26126r0014
About this file
This is a Standard Work document from the VA Northern California Health Care System (VANCHCS) that establishes procedures for Admission Medication Reconciliation (Med Rec). Last updated on September 9, 2022, and owned by the Chief of Hospital Medicine, the document outlines a five-step process performed by Hospital Medicine Providers and Pharmacy staff, with the trigger being DC Planning RPIE.
The standard work process begins with the admitting provider performing and documenting initial medication reconciliation in the History & Physical (H&P) by obtaining accurate medication information from the patient, family, or other sources. The admitting provider then identifies patients at high risk for inaccurate med rec, including those with confusion, dementia, polypharmacy, or multiple pharmacies or providers. If secondary reconciliation is needed, the admitting or inpatient provider contacts the appropriate pharmacist—either the ED pharmacist (extension 17555) if the patient is in the Emergency Department, or the Inpatient pharmacist (extension 17060) if the patient has been admitted or the ED pharmacist is unavailable. The pharmacist then completes a secondary med rec to departmental standards and documents findings in a Med Rec note with the attending and inpatient provider listed as additional signers. Finally, the inpatient provider reviews the secondary med rec note and orders, changes, or discontinues medications as indicated, consulting with pharmacy as needed to ensure all medication discrepancies are addressed.
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Text version
VA Northern California Health Care System August 25
Standard Work: Admission Medication Reconciliation (Med Rec) Last updated: 9/9/2022 Owner: Chief of Hospital Medicine Performed by: Hospital Medicine Providers and Pharmacy Version: 1.0 Revised by: Tyler O’Flahrity Trigger: DC Planning RPIE
VANCHCS Mission:
Standard Work Applicability: Admission Medication Reconciliation (Med Rec)
Standard Work Work Performed
By Major Step Details Reason why this step is important
1 Admitting provider Med Rec performed and documented in H&P
Provider talks with patient/family/etc. to obtain accurate med rec and documents said in H&P
This is standard practice
2 Admitting provider Identify patients needing further Med Rec
Provider identifies patients at high risk for inaccurate med rec (pt. confused/dementia, polypharmacy, multiple pharmacies/providers, etc.)
Identifies patient that truly need another Med Rec from skilled professional (pharmacy)
3 Admitting vs Inpatient provider
Calls Pharmacist to complete secondary Med Rec
If patient in ED, call ED pharmacist (17555) If ED Pharm unable or patient admitted, call IP pharmacist (17060) Inpatient provider to indicate if needs consult <24hrs
Need to have direct contact for handoff/consult (closed loop)
4 Pharmacy Pharmacist to complete a secondary Med Rec and write Med Rec note with notifications to provider and attending
Pharmacy does med rec to their standards Pharmacy write Med Rec note and adds attending and inpatient provider as additional signers
Completes secondary Med Rec and notifies inpatient team of completion
5 Inpatient provider Inpatient provider reviews secondary Med Rec and adjusts as needed
Review note and order/change/discontinue medications as indicated Call Pharmacy if any questions about Med Rec
Ensure medication discrepancies found on secondary Med Rec are acted upon
File details come from the government source that posted it. Updated .