Medical Staff Portal

Medication Reconciliation

Medication Reconciliation, commonly referred to as “MedRec”, is a formal process in which healthcare providers work collaboratively to identify the most comprehensive and accurate list of medications for the patient/resident at key transitions of care (admission, transfer and discharge). 

MedRec is a Patient Safety Initiative which falls under the umbrella of Medication Management.     

The goal of MedRec is to minimize medication errors at key transitions of care (admission, transfer and discharge) via a systematic and comprehensive review of all of the medications a patient/resident is taking to ensure that medications being added, changed, or discontinued are carefully evaluated, documented and communicated.         

MedRec Auditing Frequently Asked Questions (FAQ)

What’s in It for Me?

Accreditation Canada

MedRec Tools

The MedRec process is facilitated by the use of tools at admission and discharge.

Admission BPMH Tool 

  • CV# 0199 (Edmontonn)
  • CV# 0199NCR (Rural)
  • CV# 0426 (NICU)

Transfer sticker template

  • NO CV # - do not order from DATA Group
  • Printable sticker template is compatible with Avery labels (05160, 5260, 8160, 48160, 48460, 99180)

Discharge MedRec Tool 

  • CV# 0375NCR
  • CV# 0492 (GNCH: Women's Health)
  • CV# 0425 (NICU

Admission

The cornerstone of the MedRec process upon admission is to develop the Best Possible Medication History (BPMH). It is a medication history/list which acts as the one "source of truth” of the patient/resident’s medication regimen prior to admission, to share and communicate across all disciplines.

The collection of a BPMH requires: A systematic process of interviewing the patient/resident and their family and/or  caregiver as one source of information whenever possible and reviewing at least one other reliable source (minimum 2 sources total) of information.

There are two models for completing MedRec at admission:Proactive/prospective model and retroactive /retrospective model  

Exception: Direct admits from another facility: In this case, the BPMH from the previous facility will be faxed over and serves as a history/reference only. A new BPMH is NOT to be completed. The admitting prescriber will refer to this document and any transfer orders received to order all desired admission medication orders on a Patient Care Orders sheet.

The admission BPMH then becomes the reference point for:

  1. Decisions to continue, discontinue, or modify the patient/resident’s medication regimen upon admission.
  2. Creating admission orders for the patient/resident once reviewed and signed by a prescriber.
  3. Determining the patient/resident’s medication regimen upon transfer/discharge.

Goal: compare the admission BPMH to admission medication orders to identify,communicate and resolve any discrepancies.

Studies have found that thoroughly completing an admission BPMH can minimize unintentional discrepancies (i.e. omissions, duplications, dosing errors, drug interactions, etc.) which may lead to medication errors.  

Admission BPMH Process

Direct Admissions with Complete BPMH

BPMH - Frequently Asked Questions (FAQ) 

Helpful Hints to Complete a BPMH

Using Alberta Netcare for MedRec – Frequently Asked Questions (FAQ

BPMH Interview Guide Pamphlet

How to Fill Out a BPMH Tool

Alberta Netcare BPMH Tool

Transfer

For MedRec purposes, “transfer” refers to a change in the level of care or service within-facility.  (ex. Grey Nuns Surgery to Grey Nuns Internal Medicine).

Both the sending prescriber and the accepting prescriber are responsible to review, evaluate and reconcile all medications upon transfer.  This is a process already occurring in practice.

Goal: compare the current medications the patient/resident was receiving on the unit (Medication Administration Record (MAR) or medication profile) with those that were being taken at home (Best Possible Medication History (BPMH)) to determine if any medications need to be continued, restarted, discontinued or modified at the next level of care.

To formalize this process, there is no paper MedRec “tool” to be completed. In place, a sticker or stamp will be used and completed by the SENDING prescriber only. It simply serves as a way to consistently document that the BPMH and current medication orders have been reviewed prior to transfer. See How to Complete MedRec on Transfer for more information.

MedRec on Transfer Resources

Transfer MedRecSticker

How to complete MedRec on Transfer

Discharge

Discharge refers to the end of service provision by the care facility (i.e. the patient physically exits the current facility and subsequently goes home, or to a different care facility).  

Goal: compare the current inpatient medications (Medication Administration Record (MAR) or medication profile) with those that were being taken at home (BPMH) to determine the patient/resident’s discharge medications. This is documented on the MedRec Discharge Tool.

This tool serves as a discharge prescription or order which may be sent/faxed to the patient’s community Pharmacy and/or next service provider. A copy is also provided as a record for the patient, in conjunction with a copy of the discharge summary form. Additionally, education should be provided to the patient/resident or caregiver.

How to Fill Out a Discharge Tool

Documenting MedRec on Discharge - Hybrid Tool

Quick Guide For Transfer Versus Discharge

Process Maps

The MedRec Project Team creates process maps for each Program/Unit/Site that has had MedRec implemented at all transitions of care (admission, transfer and discharge).

These process maps include the MedRec processes that the Program/Unit/Site decided upon during the implementation planning stage.

The process maps are used in educational packages and located in the Information Binders for each Program/Unit/Site for reference.

Edmonton Acute Care

Misericordia Community Hospital

MCH Surgery Inpatient Admission MedRec Flow Map

MCH NICU MedRed Admission Process

MCH Women's Health MedRed Admission Process

MCH Medicine MedRed Admission Process

MCH Mental Health MedRed Admission Process

ICU MedRed Admission Process

CCU MedRed Admission Process

Grey Nuns Community Hospital

GNCH Surgery Inpatient Admission MedRec Flow Map

GNCH NICU MedRed Admission Process

GNCH Women's Health MedRed Admission Process

GNCH Medicine MedRed Admission Process

GNCH Mental Health MedRed Admission Process

GNCH CCU MedRed Admission Process

Villa Caritas

Villa Caritas Mental Health MedRec Admission Process

Rural Services

Banff Mineral Springs Hospital MedRec Process

Bonnyville Health Centrel MedRec Process

Killam Health Centrel MedRec Process

Our Lady of the Rosary (Castor) MedRec Process

St Joseph's General Hospital (Vegreville) MedRec Process

St. Mary's Hospital (Camrose) MedRec Process

MedRec Auditing

We audit for measurement and sustainability and to ensure that new MedRec processes and tools are consistent and effective in reducing medication errors and improving patient safety. Auditing is the mechanism for learning, not judgment. Frequent measurement gives timely feedback to staff and physicians and helps keep them in engaged in making changes to improve the process. By completing audits at the unit level we are able to learn how MedRec process are working and, based on the results, make specific changes to improve.

The MedRec Auditing Process is determined by three (3) types of measures:

Success: percentage of patients with MedRec completed on admission/discharge

Quality for admission: percentage of sample population with all five (5) quality elements complete

  • Two or more sources for BPMH

  • Actual medication use verified by patient/family

  • Complete medication information (right name, dose, strength, route, frequency) 

  • Every medication accounted for in medication orders

  • Rationale included for continued, discontinued or changed medication orders

Quality for discharge: percentage of sample population with all three (3) quality elements complete

  • All medications on the admission BPMH were accounted for on discharge

  • Complete medication information (right name, dose, strength, route, frequency)

  • Rationale included for continued, discontinued or changed medication orders

Outcome: percentage of patients with one or more outstanding discrepancies

Note: measurement and evaluation strategies may change over time to ensure the measurement and evaluation strategies remain relevant and useful.       

Audit Platform and Results

The Crede Technologies Audit Tool will be used for MedRec audits to assist with the coordination of measurement and reporting. Ensure you refer to the documents below prior to conducting your first audit. For a Crede Technologies login, contact Jessica Lehman.  All other MedRec audit inquires can be directed to Alexandra Fuller.

The MedRec audit results are available for viewing on Tableau

Audits are faxed or submitted online to Crede Technologies by the last Monday of each month and the data is available for viewing approximately the 15th of the following month. Submitting completed audit forms to Crede Technologies by the deadline is important for auditors to be able to view their audit results the following month. Not submitting on time can result in delayed viewing of audit data till the next refresh of data (15th of the following month). 

Crede Technologies Quick Guide

Tip Sheet for MedRec and VTE Auditors

Quick Tips for Using Tableau

MedRec Auditing Resources

MedRec Auditing Frequently Asked Questions (FAQ)

One Page - Auditor Responsiblities

Quick Guide for Admission Audit Measures

Sample Admission Audit Tool (Not For Use – obtain personalized tool from Crede Technologies)

Quick Guide for Discharge Audit Measures

Sample Discharge Audit Tool (Not For Use – obtain personalized tool from Crede Technologies)

Three Step Ladder System

Audit Action Plan Template

My Medication List Brochure

A current and accurate medication list can help prevent adverse drug events and help healthcare professionals make decisions about a patients health.

The My Medication List brochure is a resource to start a conversation with patients to help them manage their medications.

The purpose of My Medication List brochure is :

  • To engage and educate patients on the importance of having a current and accurate medication list.
  • To support patients on how to create an accurate medication list.

The My Medication List brochure is recommended to be discussed with patients needing assistance with medication management.

To help staff and physicians with the purpose of the brochure and how to use the brochure, information sheets to facilitate education have been included below.

For more information or questions, please contact Alexandra Fuller.

Education Information

Manager/Educator Information (click here to download poster)

Nursing Information

Pharmacy Information

Physician Information

Ordering Information

My Medication List brochure is available from DATA Group:

  • CV - 0649
  • Cost: Packages of 50 $15.27 per pack

Resources

Medication Lists and Tools
Know Your Medications
Safe Medication Use

ISMP Canada's "5 Questions to Ask about your Medications"

Patients are at high risk of fragmented care, adverse drug events, and medication errors during transitions of care. Ensuring safe medication transitions is complex. It requires patients to be an active partner in their health to ensure that they have the information they need to use their medications safely.

Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, Patients for Patient Safety Canada, the Canadian Pharmacist Association and the Canadian Society for Hospital Pharmacists have collaborated to develop a set of 5 questions to help patients and caregivers start a conversation about medications to improve communications with their health care provider.

Please consider using this poster to encourage staff, physicians and patients/family to be familiar with

Resources

5 Questions to Ask About Your Medication (English)

5 Questions to Ask About Your Medication (French)

Questions/Contact Information

Medication.Management@covenanthealth.ca