Enhance the Med-Rec Process

by Steven Dashiell
Published on Aug 03, 2015

Medication reconciliation always has been complicated but has become even more so with the advent of EHRs. Sometimes there is a failure to sufficiently plan out what the hospital requires from its EHR system when it comes to medication reconciliation. It's not unusual, for example, to encounter a med-rec processs that requires 7 different screen changes. 

An ideal EHR medication management system would pull medication lists from various sources, including pharmacies and previous visits, and present that list in a way that physicians can use to make a treatment plan. Of course, that's the ideal.  In the real world, it doesn’t matter where such a medication list comes from because the clinician must still engage with the patient and ask what medications he is currently taking. A list only provides what was prescribed, not what the patient is taking. However, the list can provide a starting point to start that chat and edit those medications on the list.

To build a good med-rec program, pay special attention to the workflow involved of those who will be actively participating in the medication management process. Include doctors, nurses and pharmacists in the planning when considering EHR enhancements to that process.  Once you create a visual workflow, you can present it to your EHR vendor and tell them ‘This is what our workflow looks like. How can your system to support this.'  The med-rec process in your EHR should be easy to use and as intuitive as possible. 

Employing clinical pharmacists in your hospital to assist with reconciliation efforts is a best practice.  And if your hospital already has pharmacists on the floor, try freeing up more time for them to dedicate to the task.  More and more hospitals turn to pharmacists to enhance the med-rec process, a practice that has become more popular in recent years. The American Society of Health-System Pharmacists (ASHP) advocates for pharmacists to take on a leadership in medication reconciliation, noting their distinct role and skills in working with medications.

Approximately 57% of hospitals are currently using pharmacy staff in their medication-reconciliation processes, says Erika Thomas, M.B.A., B.S.Pharm, director of ASHP’s inpatient practitioners section, and Vicki Basalyga, Pharm.D., BCPS, director of ASHP’s clinical specialists and scientists section. ASHP would like to see that percentage increase.

“Pharmacists are trained to ask the right medication history questions that decrease medication-related adverse events and facilitate ‘close the loop’ communication,” note Thomas and Basalyga, responding to questions by email. “Pharmacists are the best trained professionals to conduct the major steps in medication reconciliation, including conducting the medication history process, comparing the patient’s medication history to inpatient orders and preparing the discharge medication list.”

Kick start your med-rec enhancement efforts with these tips: 

  • Outline for staff specifically why your hospital is working on medication reconciliation. This can help anyone who may be hesitant to commit more effort to the process understand why medication management is important for the patient and the hospital.
  • Bring together a team of multidisciplinary professionals who can break down each step to be included in the process. You particularly want to bring those staff members who have specific experience with each patient subset or population you will be treating.
  • Include the patient and patient's family whenever possible when designing the process.  They can tell you how you can make their lives easier. 
  • Educate patients and caregivers on the importance of staying involved in their care. Patients who know their medications, or regularly update and carry around a list of those that they are taking, can prove an immense boon to your hospital’s medication management process.
  • Look to outside resources. There is an assortment of resources that can help improve the med-rec process, such as the IHI website or other hospitals. Reconciliation improvement is going on around the world.

This blog is condensed from an article that was first published by Dorland Health