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Related article: III-19-MedicationReconciliation Purpose: Medication errors are one of Buy Cheap Lorazepam the leading causes of injury to hospital patients, and chart reviews reveal that over half of all hospital medication errors occur at the interfaces of care. [Rozich JD, Resar RK. Medication safety: One organization�s approach to the challenge. JCOM. 2001;8(10):27-34.] Medication reconciliation is defined as a formal process of obtaining a complete and accurate list of each patient�s current home medications including name, dosage, frequency and route and comparing admission, transfer, and/or discharge medication orders to that list. Discrepancies are brought to the attention of the prescriber and, if appropriate, changes are made to the orders. Any resulting changes in orders are documented. Overview The process involves three steps: 1. Verification (collection of medication history) 2. Clarification (ensuring that the medications and doses are appropriate) 3. Documentation (changes to orders or reason for differences) Process Clinical staff (Physicians, Pharmacists, Registered Nurses and Social Workers) will interview the consumer, or family member to ascertain an accurate listing of all medication (Rx, OTC and herbal products) currently used Buy Cheap Lorazepam at time of admission. Staff may also review prescription containers submitted at admission to ascertain the medication history. If medication history information is not available at admission, the physician should treat symptomatically and the social worker should contact family representative for information/follow-up. If medication history is not available, medical staff should specify symptomatic treatment on admission orders. This information should be faxed to the pharmacy as soon as possible for reconciliation. Clinical staff will document current list of medications on ECRH Pre- Admission Assessment (CLN 040- pg 3) report or ECRH Admission Evaluation Form (MH001-pg2) report. Pharmacy prefers CLN040 format to insure adequate space to record medications and reconciliation notes. Admission history reports will be faxed to the pharmacy by admitting personnel designated by the Clinical Director. Clinical Pharmacist will compare drugs ordered using physician admission orders with information documented in admission history report for said consumer. This should occur ,during the routine work week, within 24 hours of receiving the physician admission medication orders. Attending physician should be notified ASAP of prescription drug omissions or dosage discrepancies, which could be harmful to the consumer. The reviewing clinical pharmacist will not notify the physician if another drug in the same therapeutic class was ordered (i.e. Seroquel ordered �but admission history indicates consumer was previously on Risperdal). Clinical Pharmacist will document on the admission history report that reconciliation was completed, sign and date. Documentation of all discrepancies will be annotated on said medication history report. Pharmacy staff will annotate therapeutic substitutions with the phrase SUBSTITUTION FOR (drug name) in the note field of the drug approved for dispensing. This will appear Buy Cheap Lorazepam on MARs and physician /pharmacist discharge reports to alert clinicians that a substitution was made during the course of patient stay. Nurses and discharge pharmacists will be alerted to this and counsel consumer to prevent over dosage (personal medication returned +discharge medication) secondary to use of two drugs in the same therapeutic class. Pharmacy will maintain a Reconciliation notebook of all admissions /reconciliations. Clinical Pharmacist will note on the admission report any discrepancies and document physician contact responses relative to reconciliation. Medication reconciliation should be completed daily. Using the automated renewals that retrieve current medication list from Worx computer system automatically completes consumer Transfer- Reconciliation. Receiving physician should run report when consumer transferred into designated area. Consumer Discharge-Reconciliation is automatically completed by using the automated physician discharge report that retrieves current medication list from Worx computer system Physician should run report when consumer discharged from ECRH. Physician admission history (H&P), admission orders, transfer orders and discharge orders are available in consumer chart for staff to review to insure medication reconciliation is complete at ECRH. III-20 DISCHARGE AND PASS MEDICATIONS A. Discharge medications: The ECRH Pharmacy provides medications for its patients/clients that are discharged or go on pass (except TIC and respite admissions at GSSH). There are specific policies about the amounts and other things as they relate to the type of patient/clients that is being served. These will be discussed in their specific section. All discharge and pass medications orders must contain complete dispensing instructions, including patients name, drug name, strength, form, quantity, and directions. The physician must sign Buy Cheap Lorazepam and date the order. A separate prescription with a DEA number is needed to dispense Schedule II medication to discharged patients. Patients will be offered counseling on their medication and medication information leaflets will be sent along with the medication. 1. Discharge medications at Augusta Campus: At Augusta Campus medications must be written on a patients discharge form (MH 5-5-410 in appendix). A maximum of 7 days supply can be dispensed for Augusta Campus patients. To receive schedule II medications a separate prescription including the physicians DEA number, must be written. Liquid psychotropic medications are not dispensed to patients without careful counseling of the patient or caregiver to prevent medication errors. Prior arrangements must be made with the pharmacy for this type of medication to be dispensed. A progress note must be entered into the patients record stating the necessity for dispensing this dosage form. 2. Discharge medications at Gracewood Campus: At Gracewood Campus medications are written on the physicians order form. A maximum of 7 days supply can be dispensed, for Gracewood Campus clients. Pass medications: Consumers who are not being discharged from an ECRH hospital but are temporarily leaving the campus may receive pass medications. Buy Cheap Lorazepam Medication orders must be written on the physicians order form Buy Cheap Lorazepam with complete dispensing information. The date and time of departure and return must be included on the order. To receive schedule II medications a separate prescription including the physicians DEA number, must be written. In the long term care areas (MR) the following procedures must be followed: 1) The parent/guardian must notify the appropriate Living Area at least 3 days in advance of departure. Each Living Area should assign a person to notify and coordinate with the Physician the vacation drug needs of the client. The Physician will determine which medications the client must have during the stay and which they may do without. An order properly completed with the client name, drug name and strength and amount to be dispensed must be filled out. The physician must sign the order. A regular physician's order form should be used for this purpose. An addressograph should be used at the top of the form. The exact date and time of the client's departure and return should be on the order. Topical preparations should be sent home with the client from the client's living area drug supply (i.e. the client's own filled prescription labeled from the pharmacy). These items must have a pharmacy label on them, the nurse should request that Buy Cheap Lorazepam the family return the topicals when the client returns to the hospital 2) The pharmacy will prepare the pass medications and send them to the client's living area. Such medication will be dispatched one day prior to the departure of the client or on Friday, if the client is to leave the institution on the weekend. The medication will be delivered in a separate paper bag entitled "Pass Medication" with the name of the client written on the bag. The nurse must check the medication upon receipt against the client's records for corrections. 3) The nurse will be responsible for giving the medication to parents/guardians or others having responsibility for the client while away from the institution and for instructing them in its proper use. The nurse will document this activity on appropriate form(s). 4) Unexpected departures The pharmacist on call will be notified by the appropriate personnel when clients are going home unexpectedly, when the Pharmacy is not open. The MOD/OD must write the order for the client's medication. The pharmacist will return to Pharmacy, fill and dispense the medication, and verify with nursing personnel or other personnel the medications being furnished. The OD on the Augusta Campus may send properly labeled prescription medication from consumer�s cassette when the pharmacy is closed and time does not permit the Pharmacist to return to the facility and dispense the medications.
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