Medication Reconciliation at Mount Sinai Hospital

the medication reconciliation process at Mount Sinai Hospital is truly multidisciplinary we are using technology to facilitate sharing of information amongst not only healthcare providers but also with our patients what happens is at admission the pharmacy team takes the lead to ensure that the best possible medication history is obtained and then they perform the medication reconciliation this information is entered into the electronic health record where it becomes available to the remainder of the medical team the information in our electronic health record is then used to reconcile medications at the various transfer points in their hospital admission this would include when they initially come in from the emergency department up to the medical floor as well as at discharge when they're leaving our facility because of the limitation of our current electronic health record we augmented an existing web-based application our discharge summary to allow physicians to perform medication reconciliation at the end of service we currently have a good process using our electronic health record to support collecting best possible medication histories and performing medication reconciliation on admission but med rec needs to occur at each transition point in care this tool really helps allow members of the clinical team to build on each other's work to prevent medication errors when patients transition out of our hospital and into the community or another health care facility all caregivers from physicians to nurses to pharmacists should be involved in medication reconciliation in order for it to be an effective process to reduce medication errors and enhance patient safety the web-based application works by pulling up the home medications which were entered by the pharmacist at admission as well as the active medications that have been ordered for the patient during their inpatient visit the physician then has the option to determine whether the medication should be continued or discontinued at the time of discharge for those medications that are being continued the physician then goes on to decide whether a prescription should be generated finally the web-based application gives the physician the option of creating a prescription and printing it off right away the print off can then be handed directly to the patient at the time of discharge with their discharge summary the electronic medication reconciliation tool helps nurses to clearly outline the patient's discharge medication plan and list the medications according to four categories continued on these home medications continue on the following home medications that have been adjusted start on the following new medications and stop the following medications from home nurses also play a key role in the discharge process and the education of patients and their families with regards to medications the education done with patients and their families by nurses is facilitated and reinforced by using the electronic discharge summary to guide the conversation and reinforce information received one of the advantages of using this electronic tool for medication reconciliation is that it automatically pulls data that exists within the electronic health record and inputs it into the web-based application this minimizes the omission errors that are possible when physicians have to manually enter each medication at the time of discharge we've received great feedback from medical residents staff physicians and our co directors in the Darryl Katz urgent and critical care subtor of excellence everyone sees the benefits of improving medication reconciliation at transitions for our patients on the general internal medicine service and our acute care of the elderly I'm glad that they've come up with this new tool because it gives me a copy of all the medications that I'm gonna be taking upon my discharge and that's really helpful seeing as how I take so many and I can't really remember them all when I'm being discharged I can also show the list to my family members and then you know when they go pick the scripts for me or put them in for me they know exactly what I have to take and what's different from the last time and also what's different this time and then the last part is when I take it into the pharmacist game if they have any questions it's right there on the forum for them also and they can also put it on my file for later on when they need it this electronic tool has greatly improved the medication reconciliation process on our general internal medicine acute care of the elderly unit and our orthopedic hospital is serviced because of the success we are planning to roll this out to other areas of the hospital in the near future

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