Appendix, Building the Foundation for Your Medication Reconciliation Process Design

Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation

Many organizations are uncertain about how to proceed with designing a workable solution for medication reconciliation. This section provides helpful information and tools for designing or redesigning a medication reconciliation process.

 Building the Foundation for Your Medication Reconciliation Process Design

  • Process design—should center on the concept of a single list to document patient's current medications ("one source of truth").
  • Defining roles and responsibilities for medication reconciliation—determine which discipline(s) should be involved in each step of your medication reconciliation process, including their respective roles and responsibilities.
  • Integrating medication reconciliation into your existing workflow—prompts to complete required steps for medication reconciliation are essential.

Medication Reconciliation Upon Admission: High-Level Process Map BEFORE Redesign

  • Multiple, independent medication histories obtained from patient and documented throughout the medical record.
  • No prompts to cross-reference documentation, which may be conflicting.

Chart shows the following process: Patient Admitted to Hospital; Nurse obtains medication history and documents in the nursing admission patient assessment form. Physician obtains medication history and documents in admission note ('history and physical'). Changes or updates to history 'buried' in progress notes.

Medication Reconciliation Upon Admission: High-Level Process Map AFTER Redesign

Chart shows the following process: Patient Admitted to Hospital.

Medication Reconciliation Upon Discharge: High Level Process Map AFTER Redesign

Chart shows the following process: Patient Being Discharged From Hospital.

[Insert your Organization's Logo Here]Patient Name:
MR#:
Date:
Fin #:

Your Current Medication List (Name___________________________________________________
____________________________________________________________________________________ )

Please complete the following information. A registered nurse will review this list and update it, if needed, when you arrive for your surgery, procedure, or test.

ALLERGIES: None _____ (please check none) or list:

Source of AllergyReactionSource of AllergyReaction
Example: PenicillinHives3. 
1. 4. 
2. 5. 

&mbsp

Medication List the names of any medications you are taking. Please include any over the counter medicines (including vitamins, minerals, and herbal supplements). Also include any medications you held for your procedure.Strength List the strength of each tablet, capsule, etc.Dose How much are you taking? (number of tablets, capsules, units, etc.)Frequency How often do you take the medication? (daily, twice a day, monthly, etc.)Route How are you taking this medication? (by mouth, injection, patch, etc.)Last Dose Taken Indicate the date and time of the last dose taken
Example: Toprol XL100 mg1 Tabletevery dayby mouththis morning
      
      
      
      
      
      
      
      
Current as of August 2012
Internet Citation: Appendix, Building the Foundation for Your Medication Reconciliation Process Design: Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation. August 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/match/matchap6.html