Medication reconciliation (“med rec”) is a process designed to prevent medication errors at patient transition points. The key step in the med rec process is the determination of the patient’s home medication regimen or the “Best Possible Medication History” (BPMH). Admission med rec processes fit into two models; retroactive and proactive. A retroactive med rec process occurs when a physician has already written admission medication orders. In this instance, the BPMH is obtained afterwards, and then compared with the admission medication orders to identify any unexplained discrepancies. The flaw in this process is that there is a time delay between the time the original orders are written and the reconciliation process, which can potentially cause medications errors and patient harm. The proactive med rec process is ideal and occurs when the BPMH is created first and is referred to by the physician when writing admission medication orders. In this scenario, the medication reconciliation process does not exist since the physician clearly communicates intentions when ordering home medications.

The practice initiated at Central Health was the integration of a pharmacy technician in the emergency department (ED) to collect the BPMH for all admitted patients, at the earliest opportunity, thereby facilitating a proactive med rec process and decreasing potential medication errors.

 

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