Electronic Medication Reconciliation at Admission

The journey of Medication Reconciliation (MedRec) at Admission has been a challenging yet exciting one. Over the years we have evolved from a paper based manual practice to our current electronic based automated reconciliation process. Our early MedRec practice predominantly involved obtaining a best possible medication history (BPMH) through interviewing the patient, a family member, and/or care provider. In addition to this practice we have since involved community Pharmacies in obtaining patients’ medication history (MedHx) prior to elective surgery through the Ontario MedsCheck program. Following this collaboration TEGH subsequently implemented computerized provider order entry (CPOE) throughout the organization and rapidly adopted electronic MedRec in the process. The progression to electronic MedRec at admission has been extremely successful. It is currently used in both inpatient and outpatient settings, utilizing the same process and electronic platform in different care areas throughout our hospital. Furthermore, MedRec at admission provides the foundation for automating MedRec at discharge, making the latter process a proactive one for Physicians ready to send their patients home. With the approval of new medical directives for Pharmacists and Physician Assistants’ role in MedRec and the involvement of nursing in our Virtual Ward discharge program, MedRec has truly become an inter-professional practice throughout the continuum of patient care at TEGH.