D.26- MCP 11-146 MEDICATION RECONCILIATION AUG 2021.pdf

MEDICATION RECONCILIATION

MCP 11-146

Syracuse VA Medical Center Syracuse, NY 13210

Signatory Authority:

Medical Center Director

Responsible Owner:

Chief, Pharmacy Service

Rescinded Document:

MCPM 11-146, Medication

Reconciliation, dated July 1, 2019

Effective Date:

August 2021

Recertification Date:

August 2026

1. POLICY

This medical center policy (MCP) establishes local policy for medication reconciliation to prevent adverse drug events associated with incomplete reconciliation of a patient’s medications as the patient proceeds through the continuum of care provided by the Medical Center.

2. JUSTIFICATION

This policy is written in accordance with VHA Directive 2011-012, VHA Medication Reconciliation, dated March 9, 2011, which mandates a local policy be in place that conforms to critical quality and safety elements.

3. RESPONSIBILITIES

In the Outpatient setting:

a. Medical Provider. The medical provider is responsible for:

(1) Providing medical treatment or ordering medications.

(2) Creating an accurate list of the patient’s medications, reconciling the list of mediations, reviewing medication changes with the patient, documenting the reconciliation, and ensuring the patient has an accurate and complete listing of medications upon completion of the patient appointment.

b. Home-Based Primary Care (HBPC) Provider. The HBPC provider is responsible for:

(1) All PACT HBPC patients managed by the HBPC provider. (See ‘Ambulatory Care and Specialty Clinics’ section for Tailored Care HBPC patients.)

(2) All medications (including OTCs, vitamins, supplements, and herbal products), from all sources will be reviewed and updated with patient/caregiver by the HBPC provider or nurse at each home visit. A medication list will be left with the

Attachment D.26 RFP 36C24224R0049

August 2021 MCP 11-146 patient/caregiver at each home visit. If medications changes are noted during the visit, the medication list will be updated with handwritten notes.

c. Home-Based Primary Care (HBPC) Nurse. The HBPC nurse is responsible for:

(1) Alerting managing provider (HBPC provider or Primary Care provider) of any discrepancy to the medication list.

(a) Once the medication discrepancy is reconciled, and the medication list is updated by the HBPC or Primary Care provider, a new medication list will be delivered to the patient at the next home visit, or by mail.

In the Inpatient setting:

d. Provider. The provider is responsible for:

(1) Creating an accurate list of the patient’s medications.

e. Pharmacist. The pharmacist is responsible for:

(1) Performing the admission medication reconciliation process and will document the admission reconciliation process in the medical record within 24 hours of admission for full admissions, as well as for observation admissions not discharged within 24 hours of their admission.

(a) The admission medication reconciliation process will include a patient interview when possible.

f. Inpatient Pharmacist. The inpatient pharmacist is responsible for:

(1) Performing medication reconciliation when patients are transferred from one level of care to another within the Medical Center and documenting the transfer medication reconciliation process within the medical record.

g. Discharge Pharmacist. The discharge pharmacist is responsible for:

(1) Providing the patient with their discharge medication list and medication education after the discharge medication reconciliation process has been completed.

h. Clinical Service Chief. All Clinical Service Chiefs are responsible for:

(1) Ensuring the medical staff and other providers with prescriptive privileges are educated, trained, aware of and comply with this policy.

i. Professional staff. All professional staff (Nursing, Social Work, Dietary, Pharmacy) are responsible for:

(1) Ensuring they are educated, trained, aware of, and comply with this policy.

j. Chief of Staff. The Chief of Staff, Associate Director for Patient/Nursing Services, and Managers/Supervisors are responsible for:

(1) Providing guidance and ensuring compliance with the provisions of this policy.

4. OTHER PARAGRAPHS

a. Hospital Setting Inpatient Admission/Transfer/Discharge

(1) Admission

(a) Identifying Unreconciled Medications at Admission: The Pharmacist will look for discrepancies in medication orders between outpatient and inpatient settings. Identified discrepancies will be communicated to the provider and documented in the patient’s medical record. Admission medication reconciliation will involve an interactive patient medication history when possible. Admission medication reconciliation will be completed within 24 hours of the patient being admitted.

(b) Documentation of the admission medication reconciliation process will include indicating (in the following or similar wording) that:

1. The medication list was reviewed with the patient/caregiver, or

2. The patient/caregiver refused or was unable to participate in review of the medication list.

(2) Transfer

(a) Identifying Unreconciled Medications at Transfer: Each time a patient is transferred from one level of care to another within the Medical Center the inpatient pharmacist will review medication orders alongside new orders and/or plans for care and resolve any discrepancies. Resolution for any identified discrepancies will be communicated to the provider and documented in the patient’s medical record.

(3) Discharge

(a) Identifying Unreconciled Medications at Discharge: upon identification of a patient for discharge, the discharge pharmacist will review the patient’s inpatient medications, the outpatient medications prior to admission including the prescription day’s supply and last fill date. Discrepancies will be communicated to the patient’s provider for resolution and documented in the patient’s record. Upon discharge medication counseling, the discharge pharmacist will provide a list of medications to the patient.

b. Ambulatory Care and Specialty Clinics

(1) Medication reconciliation for ambulatory care and specialty clinic patients in the clinic setting is primarily the responsibility of the provider. It includes processes to completely reconcile medications during the clinic visit and provide the patient/caregiver with an accurate list of their medications upon discharge from the clinic setting when changes in medication have occurred or if the patient does not have a medication list.

(2) If the patient is co-managed by VA and non-VA providers, the patient will be responsible for providing their VA medication list to the non-VA provider(s). Patients may be given a copy of their medication list to give to their non-VA provider(s), or they may be instructed to authorize the provision of this information to their non-VA provider(s) through Release of Information.

(3) Medication reconciliation will be required at each clinic visit. Upon admission to an ambulatory clinic setting, the provider will review with the patient/caregiver the medications the patient is currently taking and reconcile against the list of medications in the patient’s medical record.

(4) A written copy of the reconciled medication list will be provided to the patient/caregiver at the completion of the clinic visit, unless:

(a) The provider verifies that the patient/caregiver has their own medication list.

(b) The patient/caregiver refuses a copy of the reconciled medication list.

(5) Each clinic setting will determine a process to print the updated medication list from the patient’s medical record (CPRS Reports tab, Health Summary, Medication Reconciliation, or templated progress note) and provide to the patient.

(6) Documentation of the medication reconciliation process will include indicating (in the following or similar wording) that:

(a) The medication list was reviewed with the patient/caregiver, or

(b) The patient/caregiver refused or was unable to participate in review of the medication list, or

(c) A copy of the reconciled medication list was provided to the patient/caregiver, or

(d) A copy of the reconciled medication list was not provided to the patient/caregiver due to patient/caregiver having their own medication list or refusing a copy of the reconciled medication list.

c. Emergency Department

(1) Upon admission to the Emergency Department, the triage nurse will conduct a screening reconciliation obtaining the list of the patient’s current medications. Direct communication with the patient/ caregiver is necessary as it cannot be assumed that the list of Outpatient medications and the non-VA medications in the Medical Record is correct.

(2) The ED provider will provide a focused reconciliation; reviewing with the patient/caregiver the medications the patient is currently taking and reconciling against the list of medications in the patient’s medical record (Outpatient Medication and Non- VA Medications).

(3) For patients that are to be admitted the Medical Center, a full reconciliation will be conducted as described in the inpatient admission process.

(4) Patients discharged from the ED: Documentation of the discharge medication reconciliation process will include indicating (in the following or similar wording) that a copy of the discharge medication list was provided to the patient/caregiver.

d. Specialty Treatment Care and Diagnostic Services

(1) The following applies to all settings during which a planned treatment/diagnostic procedure occurs if medications are to be administered, or if the patient’s response to the treatment/diagnostic procedure could be affected by the medications the patient has been taking. This applies to both inpatients and outpatients in treatment/diagnostic settings.

(2) For procedures during which medications will be administered, a list of the patient’s current medications will be reviewed with the patient and updated by the provider. The list will be screened for potential drug interactions with any medications that will be administered during the procedure.

(3) If in post procedure additional medications are ordered for the patient, the patient will be provided with an updated list of their medications upon discharge from the procedural area to an outpatient setting.

(4) Each setting will determine a process to print the updated medication list from the patient’s medical record (CPRS Reports tab, Health Summary, Medication Reconciliation, or templated progress note) and provide to the patient.

(5) Documentation of the discharge medication reconciliation process will include indicating (in the following or similar wording) that a copy of the discharge medication list was provided to the patient/caregiver.

e. Quality Assurance

(1) Compliance with the documentation requirements for the medication reconciliation process will be monitored through External Peer Review Process (EPRP).

(2) VHA Directive 2011-012 recommends that facilities monitor compliance as appropriate with resources being EPRP and VA Med Rec Performance Monitor (IPEC).

5. DEFINITIONS

None.

6. REFERENCES

a. VHA Directive 1164, Essential Medication Information Standards , dated June 26, 2015, DIRECT LINK .

b. VHA Directive 2011-012, VHA Medication Reconciliation Directive, dated March

9, 2011, DIRECT LINK .

c. Joint Commission National Patient Safety Goal 03.06.01, dated 2012 , DIRECT

LINK.

7. RESCISSION

MCPM 11-146, Medication Reconciliation, dated July 1, 2016, is rescinded.

8. REVIEW

At minimum at recertification and including when there are changes to the governing document (for example, national policy or a health care accreditation body mandate).

9. RECERTIFICATION

This MCP is scheduled for recertification on or before the last working day of August 2026. This MCP will continue to serve as local policy until it is recertified or rescinded.

In the event of contradiction with national policy, the national policy supersedes and controls.

10. SIGNATORY AUTHORITY

FRANK P. PEARSON, DPT, PA-C

CAPT, USN (Ret) U.S. Department of Veterans Affairs Director, Syracuse VA Medical Center Date Approved: August 2, 2021

NOTE: The signature remains valid until rescinded by an appropriate administrative action.

DISTRIBUTION: MCPs are available at: Syracuse Medical Center Document Control SharePoint (DCS). https://dvagov.sharepoint.com/sites/VHASYR/svdc.

Attachment D.26 RFP 36C24224R0049 https://dvagov.sharepoint.com/sites/VHASYR/svdc/ https://dvagov.sharepoint.com/sites/VHASYR/svdc/ https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/npsg_chapter_ncc_jan2021.pdf https://www.jointcommission.org/-/media/tjc/documents/standards/national-patient-safety-goals/2021/npsg_chapter_ncc_jan2021.pdf https://www.jointcommission.org/standards/national-patient-safety-goals/ https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3133 https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=3119 https://vaww.va.gov/vhapublications/index.cfm https://vaww.va.gov/vhapublications/index.cfm