Figure 4: Medication Reconciliation Upon Discharge: High Level Process Map After Redesign (Text Description)
The flowchart begins with Patient discharged from Hospital. Directly below this, in the center of the chart is:
Med Profile ("One Source of Truth")
Medication(s) Being Given
with space to record current and past medications.
Following that is:
Prescription(s)/Home Medications (outpatient)
with space to record current and past prescriptions.
Flowing into the Med Profile is:
- Physician places medication reconciliation order and reviews hospital orders and pre-admission medication list.
- Physician updates prescription/home medications to reflect new discharge medication list.
- Nurse completes nursing discharge note and is prompted to confirm patient is being discharged with an updated home medication list from the physician.
- Patient is counseled.
- Physician is consulted for resolution of discrepancies and questions.
Flowing out of the Med Profile is:
- Physician pulls updated home medication list into discharge instructions (for patient) and discharge summary (for next provider of care), highlighting changes.
- Single location for documenting and confirming home medications, share by all disciplines.
- "One Source of Truth" for review and reconciliation of inpatient and outpatient medications.
- Changes and updates to home medications clearly accessible.
- Prescription/home medication information remains stored in the current folder and is available for review and modifications for future admissions.
- Standardizes physician review and documentation of home medications in preparation for discharge.
- Template provides reminders and section for physician to highlight changes to prior medications and document new prescription information.
- Creates standardized process for nurses to identify, resolve, and document followup on unintended discrepancies at discharge.
Sequence of Tasks:
- Physician places medication reconciliation order, performs reconciliation, and updates home medication list in preparation for discharge.
- Nurse prompted to confirm history patient receives an updated medication list upon completion of nursing discharge form.
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