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• Home Community Care
• Medication Reconciliation

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Medication Reconciliation Process

• Medication Risk Assessment Tool (MedRAT)
  identifies high risk clients requiring medication
  reconciliation
• Best Possible Medication History (BPMH) completed
  and sent to Physician for reconciliation
• MedRAT and BPMH also sent to participating
  Community Pharmacists for in-depth medication
  review

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MEDICATION RISK ASSESSMENT TOOL

• 1.      IS THE CLIENTS MEDICATION REGIMEN 
• Simple
• Complex (please see reverse
  for more information)
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• 2.      IS THE CLIENTS MEDICATION
  ADHERENCE BEST DESCRIBED AS
• Taking as prescribed
• Chaotic (If chaotic, tick possible reasons
  below)
• ____ Impaired cognition
• ____ Impaired vision, hearing, swallowing
• ____ Lacks necessary support
• ____ Lower literacy or ESL issues
• ____ Side effects
• ____ Cost
• ____ Clients beliefs/expectations
• ____ Lacks basic understanding of
  medications
• ____ Other (describe) _______________________
  __________________
• 3. IS THE CLIENT ON ANY HIGH-RISK
  MEDICATIONS?
• ( see reverse for more information)

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MEDICATION RISK ASSESSMENT TOOL

• Examples of factors which increase complexity in
  a medication regimen 
• Greater than 5 medications (include prescription,
  OTCs, herbals, etc)
• Greater than 3 times a day dosing frequency
• More than 2 methods of medication administration
  eg oral, drops, patches, nebulizers, etc
• More than 2 prescribers
• More than 2 pharmacies (include online pharmacy,
  if clients are using that)
• Many OTC/herbal/alternative products
• Multiple caregivers involved in medication
  administration (consider family, neighbours,
  friends, Community Health Workers, etc)
• Medications or doses changing frequently

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MEDICATION RISK ASSESSMENT TOOL

• Examples of chaotic medication adherence
• (Occasional missed doses are considered normal)
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• No evidence of organized approach to medication
  administration
• Blisterpacks that appear to be randomly punched
  out
• Medications left out of containers and lying
  around the house
• Client stating theyre not sure when they last
  took medications or that they know they are
  forgetting some doses (more than occasionally),
  or that theyre mixed up about their
  medications

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MEDICATION RISK ASSESSMENT TOOL

• High-risk medications
•  
• These medications are especially problematic for
  people in the over 65 years
• of age group, but also carry some risk for those
  under 65
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• Narcotics
• NSAIDs eg Advil, Ibuprofen
• Anxiolytics eg Ativan, Buspirone
• Antipsychotics
• Digoxin
• Anticoagulants eg Warfarin
• Dilantin
• Antihistamines
• Tricyclic antidepressants eg Amitriptyline
• Beta-blockers
• Insulin

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Best Possible Medication History

• Sources of Information
• Client Referral Form/Home Care Admission Orders
• Client/Family/Caregiver
• Acute Care Medication List/Profile
• Discharge Orders/Prescriptions
• RAI (Date RAI completed)____________
• Provincial Drug Database
• MAR
• Medication Vials/Containers/Bubblepacks
• Community Pharmacy

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Tools

• BPMH form
• Picture Tool
• Tips for Taking a Medication History

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Best Possible Medication History
Home Community Care Medication Reconciliation
ALLERGIES Home Medication
Profile

•  
•   

• PHYSICIAN INSTRUCTIONS
• Please confirm the following medications
  currently being taken at home by ticking the
  appropriate boxes marked YES, NO or CHANGE.
• If any medications are to be discontinued or
  changed complete the physician orders attached,
  including reason for change and send prescription
  to the Pharmacy.
• Please Sign and Date at the bottom of the page
  where indicated

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Best Possible Medication History

• Categorization of Discrepancies
• 0. No discrepancy
• 1. Med not currently prescribed
• 2. Different dose
• 3. Different frequency
• 4. Different route
• 5. Client no longer taking med
• 6. OTC not taking as directed
• 7. Other

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Best Possible Medication History
Home Community Care Medication Reconciliation
ALLERGIES Home Medication
Profile

• The following is a list of all the non-prescribed
  medications this client is taking including the
  over the counters (OTC) and Herbal medications
• Please review as may have potential for
  interactions
• Please Sign and Date at the bottom of the page
  where indicated

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Best Possible Medication History
Home Community Care Medication Reconciliation
ALLERGIES PHYSICIAN ORDER for new or
changed home medication (if CHANGE box ticked)

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Picture Tool
When talking with your doctor, nurse,
or pharmacist always remember to include
medicines you take every day, but also include
ones you only take sometimes such as for a cold,
stomachache or headache.

• DONT FORGET THESE TYPES OF MEDICATIONS
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Eye Drops Injections
Liquids Patches Nasal
Sprays Inhalers
Ointment/Creams
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Tips for Taking a Med History

• TIPS FOR TAKING A MEDICATION HISTORY
• Question 1 relates to MedRAT Question 1 simple
  vs complex medication regimen
• A complete medication profile principle of
  respectful sleuthing
•   Names/phone nos of all
  pharmacies used (check re use of online drug
  ordering).
• Confirm clients allergy list and
  describe any reactions to meds
• Questions 2 and 3 relate to MedRAT Question 2
  adherence vs chaos
• Clients perception of purpose of medications
• Should know the basic names and
  purposes of each medication.
• Clients perception of
  effectiveness of medications
• Clients ability to self-administer medications
• Cognitive status judgment,
  reasoning, understanding, diagnosis of dementia,
• cognitive testing
• Any physical/sensory/emotional
  barriers fine motor control, vision,
  swallowing,
• motivation

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Plan For Spread

• Integrate MedRAT into common practice for Nurses
  and Case Managers
• Expand conditions for testing Med Rec process
• - additional clinicians in Duncan
• - SARIN Case Managers and HF Nurse
• - another HU in South Island
• Hold the gains obtained and plan spread to other
  Health Units