When a patient is discharged from hospital\nback to the community, there is increase\npossibility of medication error. To help minimize this risk of harm, a systematic\nprocedure should be implemented for receiving discharge prescriptions. <\/p>\n\n\n\n
When\na discharge prescription is received, please ensure a copy is scanned into the\npatient\u2019s file under the \u201cPaperclip\u201d tab and labelled \u201cHospital Discharge\u201d. This will allow for quick access for future\nreview.<\/p>\n\n\n\n
Perform a medication reconciliation. Compare the patient best possible medication\nrecord from our software with the discharge prescription. Ensure that any new medications prescribed for\npatients are appropriate. Some questions\nto be considered may include:<\/p>\n\n\n\n
\u2022 Is this medication appropriate\nfor my patient considering the patient\u2019s age, lifestyle, medical conditions,\nand current medications? <\/p>\n\n\n\n
\u2022 Is the medication indicated for\nmy patient? <\/p>\n\n\n\n
\u2022 Is the dosage appropriate for\nmy patient? <\/p>\n\n\n\n
\u2022 Do any of these medications\npose a risk to the patient? <\/p>\n\n\n\n
\u2022 Is this medication going to\nhelp my patient get better? <\/p>\n\n\n\n
\u2022 Are there any potential\nunintended dosage changes?<\/p>\n\n\n\n
\u2022 Will there be any possible drug\ninteractions? <\/p>\n\n\n\n
\u2022 Are there any duplicate\ntherapies?<\/p>\n\n\n\n
Differences or discrepancies between\nthese two sources of information are identified and resolved. Any questions should be resolved by\nconsulting either the discharging physician, hospital pharmacy, the patient themselves,\nthe patient\u2019s family, or even the patient\u2019s primary care physician to ensure\nthe medications prescribed are appropriate. <\/p>\n\n\n\n
Update the patient\u2019s file with the reconciled\nlist and communicate this reconciled list to the patient and others involved in\nthe circle of care.<\/p>\n\n\n\n
Document the medication reconciliation\nin the patient\u2019s file under the \u201cConsult\u201d tab. \nDocument your interpretation, decisions, and actions. Documentation should allow another pharmacist\nto understand what has taken place, why changes were made and the reason behind\nthe actions. If a hospital Medscheck was\nperformed, scan copies of the required forms into the \u201cPaperclip\u201d tab and label\nas \u201cHospital Discharge Medscheck\u201d.<\/p>\n","protected":false},"excerpt":{"rendered":"
When a patient is discharged from hospital back to the community, there is increase possibility of medication error. To help minimize this risk of harm, a systematic procedure should be implemented for receiving discharge prescriptions. When a discharge prescription is…<\/span><\/p>\n