Before determining the scope of your project, you may find it helpful to first identify all areas within your facility where patients receive medication. Create a list of practice settings that administer medications and organize it by the type of patients they serve (inpatient, outpatient, or both) and whether each setting admits or discharges patients to assist in prioritizing the scope of your project. The chart below is designed to assist you with this process.
Identify Areas within Your Organization That Administer Medications
| Practice Settings/Areas That Administer Medications | Types of Patients These Areas Serve: Inpatient, Outpatient, Both | Do These Practice Settings Also Discharge Patients? Yes/No |
|---|---|---|
| Example: Emergency Department (ED) | Example: Patients seen in the ED may be admitted (converted to inpatients) or discharged after their visit (outpatients) | Example: Yes |
| Example: Inpatient nursing units serving general medicine patients | Example: Inpatient | Example: Yes |
| Example: Transplant Clinic | Example: Outpatient | Example: Yes |
The chart below is just one step in determining the scope of your project. The additional questions below can help guide you on building the scope and charter of your project based on the nuances of your facility.
- Will the project encompass the entire facility, one department, or several departments?
- Will the project focus on one specific area of identified risk or more?
- Should you focus on one service or unit at a time? If so, which should you start with?
- Should you focus on admissions and then move to discharge or should you concentrate efforts on both at the same time?
- Should your initial scope include patients admitted through the emergency department or from procedural areas, such as ambulatory surgery?
Goals and Objectives
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General Goals and Objectives:
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SAMPLE WORKSHEET: Admission (Entry), Intra-facility Transfer and Discharge (Exit) Process Steps to Determine Disciplines Roles and Responsibilities for Medication Reconciliation
| Admission/Entry Steps | Discipline (Admission/Entry) | Discharge/Exit Steps | Discipline (Discharge/Exit) | Intra-Facility Transfer Steps (if applicable) | Discipline (Transfer) |
|---|---|---|---|---|---|
| (1) Obtain and document the patient's pre-admission (current) medications upon admission | (1) | (1) Place "discharge order" signifying patient is ready for discharge | (1) | (1) Place a "transfer order" signifying patient is ready for transfer | (1) |
| (2) Verify/confirm the patient's pre-admission medication list | (2) | (2) Review current medications and reconcile with patient's home medication list | (2) | (2) Review current medications and reconcile with patient's home medication list. Update medication orders as appropriate for new level of care. | (2) |
| (3) Reconcile patient's current medication list with medications ordered during episode of care | (3) | (3) Update preadmission medication list with any new medications, changes or deletions based on the patient's care plan for discharge | (3) | ||
| (4) Create the patient's discharge instructions which includes a complete, updated medication list for the patient, highlighting any changes to the preadmission list | (4) | ||||
| (5) Create the patient's discharge summary which includes a complete, updated medication list for the next provider of service | (5) | ||||
| (6) Educate patient on changes made to preadmission medication list | (6) | ||||
| (7) Patient's discharge summary communicated to next provider of service | (7) |
EXAMPLE: Admission (Entry), Intra-facility Transfer and Discharge (Exit) Process Steps to Determine Disciplines Roles and Responsibilities for Medication Reconciliation During Hospitalization
| Admission/Entry Steps | Discipline (Admission/Entry) | Discharge/Exit Steps | Discipline (Discharge/Exit) | Intra-Facility Transfer Steps (if applicable) | Discipline (Transfer) |
|---|---|---|---|---|---|
| (1) Obtain and document the patient's pre-admission (current) medications upon admission | (1) Physician starts list (Nurse may start list if patient admitted via Ambulatory Surgery or a Procedural Area). Nurses and pharmacists empowered to start list or document medications or changes as new information becomes available. | (1) Place "discharge order" signifying patient is ready for discharge | (1) Physician | (1) Place a "transfer order" signifying patient is ready for transfer | (1) Physician |
| (2) Verify/confirm the patient's pre-admission medication list | (2) Nurse (non-ICUs) or pharmacist (ICUs). | (2) Review current medications and reconcile with patient's home medication list in Med Profile Tab | (2) Physician | (2) Review current medications and reconcile with patient's home medication list in Med Profile Tab. Update medication orders as appropriate for new care setting. | (2) Physician |
| (3) Reconcile patient's current medication list with medications ordered upon admission | (3) Nurse and/or pharmacist depending on nursing unit | (3) Update pre-admission medication list with any new medications, changes or deletions based on the patient's care plan for discharge | (3) Physician or nurse | (3) Reconcile home medications with current medications upon transfer in to and out of the ICU to ensure pre-admission medications are held and/ or restarted appropriately during these transitions | (3) Pharmacist |
| (4) Create the patient's discharge instructions which includes a complete, updated medication list for the patient, highlighting any changes to the preadmission list | (4) Physician | ||||
| (5) Create the patient's discharge summary which includes a complete, updated medication list for the next provider of service | (5) Physician | ||||
| (6) Educate patient on changes made to preadmission medication list | (6) Physician or nurse depending on practice setting | ||||
| (7) Patient's discharge summary communicated to next provider of service | (7) Physician and/or Medical Records |
