Medication Reconciliation
IHC, in cooperation with health care providers across the state, has developed the following Medication Reconciliation toolkit. The toolkit is a compilation of forms, policies, and staff and patient education materials to support adoption of reconciliation procedures.
We would like to thank those organizations who have shared their materials. We ask that organizations using example materials to properly attribute them. Please contact IHC if your organization would like to share materials related to Medication Reconciliation.
Contributing Iowa Hospitals:
- Allen Memorial Hospital- Waterloo
- Buena Vista Regional Medical Center - Storm Lake
- Guthrie County Hospital - Guthrie Center
- Iowa Health System - Des Moines
- Mercy Medical Center - Des Moines
- Mercy Medical Center - North Iowa - Mason City
- St. Luke's Hospital - Cedar Rapids
- The University of Iowa Hospitals and Clinics - Iowa City
- Trinity Regional Medical Center - Fort Dodge
Case for Change
Project Description
Tool Kit
Implementation Planning Tools
Mercy Medical Center, Des Moines, IA (PDF 432KB)
Improving Medication Reconciliation Across Settings: Using Six Sigma Methodology
IHI: How to Guide on Medication Reconciliation (PDF 182KB)
Massachusetts Coalition for the Prevention of Medical Errors
Getting Started:
- Initiatives (Website)
Implementation tools:
- Examples of Tests of Change Worksheets (PDF 30KB)
- Planning Checklist (PDF 29KB)
- Team Member List (PDF 16KB)
- Worksheet for Reporting Tests of Change (PDF 11KB)
Forms & Policies
Hospital Policies:
- Allen Memorial Hospital, Waterloo, IA (PDF 12KB)
Admission: We created a process that allows both nursing admission documentation and the potential for a physician order. We started on paper and moved that process to the computer with a computerized nursing admission with a report that can be printed to create the paper physician order sheet. By adding this information to the computer system, it has allowed this information to be a part of our transfer/discharge report to help physicians review the pre-hospital meds at all stages of reconciliation.
Transfer/Discharge: We already had a computerized medication profile, so we used it to create a report that can be printed from our system that the physicians can review, complete and sign as actual orders. This report includes the pre-hospital list to help physicians see what the patient was on prior to admission. The pharmacy has done a lot of work with the way the medical profiles appear in the computer system to make the report more user-friendly and prevent errors.
Overall Process: The process is standard throughout the facility for inpatients and OPO patients. This helps physicians to know what to expect and what to ask and look for to reconcile medications.
- Buena Vista Regional Medical Center, Storm Lake, IA (PDF 16KB)
Medication reconciliation policy implemented in a critical access hospital.
- Grinnell Regional Medical Center, Grinnell, IA (PDF 15KB)
Guide to Reconciling Medications.
- Iowa Health System, Des Moines, IA (PDF 59KB)
Current medication reconciliation policy developed by an interdisciplinary team representing inpatient, outpatient & ambulatory settings.
- Mercy Medical Center, Des Moines, IA (PDF 24KB)
Current medication reconciliation policy addressing medication reconciliation upon admission, transfer, and discharge and guidelines for initial patient interviews.
- St. Luke's Hospital, Cedar Rapids, IA (PDF 32KB)
Medication reconciliation policy addressing reconciliation upon admission, transfer within the facility, and discharge.
- Trinity Regional Medical Center, Fort Dodge, IA (PDF 92KB)
Medication reconciliation policy addressing reconciliation upon admission, transfer within the facility, and discharge or transfer to another facility.
- University of Iowa Hospitals and Clinics, Iowa City, IA (PDF 25KB)
An interdisciplinary procedure for conducting medication reconciliation in a large teaching facility.
- Luther Midelfort, Eau Claire, WI Medication Reconciliation and Discharge Medications Policy (PDF 45KB)
An interdisciplinary procedure for conducting medication reconciliation within 24 hours of admission and at the time of discharge in order to generate an accurate medication list and thereby decrease adverse drug events.
- University of Massachusetts Memorial Medical Center, Worchester, MA (PDF 22KB)
Preadmission Medication List Verification and Order Form Guidelines.
Admission: We created a process that allows both nursing admission documentation and the potential for a physician order. We started on paper and moved that process to the computer with a computerized nursing admission with a report that can be printed to create the paper physician order sheet. By adding this information to the computer system, it has allowed this information to be a part of our transfer/discharge report to help physicians review the pre-hospital meds at all stages of reconciliation.
Transfer/Discharge: We already had a computerized medication profile, so we used it to create a report that can be printed from our system that the physicians can review, complete and sign as actual orders. This report includes the pre-hospital list to help physicians see what the patient was on prior to admission. The pharmacy has done a lot of work with the way the medical profiles appear in the computer system to make the report more user-friendly and prevent errors.
Overall Process: The process is standard throughout the facility for inpatients and OPO patients. This helps physicians to know what to expect and what to ask and look for to reconcile medications.
Medication reconciliation policy implemented in a critical access hospital.
Guide to Reconciling Medications.
Current medication reconciliation policy developed by an interdisciplinary team representing inpatient, outpatient & ambulatory settings.
Current medication reconciliation policy addressing medication reconciliation upon admission, transfer, and discharge and guidelines for initial patient interviews.
Medication reconciliation policy addressing reconciliation upon admission, transfer within the facility, and discharge.
Medication reconciliation policy addressing reconciliation upon admission, transfer within the facility, and discharge or transfer to another facility.
An interdisciplinary procedure for conducting medication reconciliation in a large teaching facility.
An interdisciplinary procedure for conducting medication reconciliation within 24 hours of admission and at the time of discharge in order to generate an accurate medication list and thereby decrease adverse drug events.
Preadmission Medication List Verification and Order Form Guidelines.
Staff Education Materials
- Buena Vista Regional Medical Center, Storm Lake, IA (PDF 13KB)
Staff education through the use of 2004-2005 JCAHO National Patient Safety Goals.
- Iowa Health System, Des Moines, IA (PDF 245KB)
An educational tool used to reinforce initial staff education on electronic medication reconciliation.
- University of Iowa Hospitals and Clinics, Iowa City, IA (PDF 82KB)
Medication Safety Screensaver.
- University of Iowa Hospitals and Clinics, Iowa City, IA (PDF 13KB)
Guideline to Medication Reconciliation: Conducting Patient Interviews.
- Massachusetts Coalition for Prevention of Medical Errors (PDF 44KB)
Example staff education materials that include staff instructions for reconciling medications at admission.
Staff education through the use of 2004-2005 JCAHO National Patient Safety Goals.
An educational tool used to reinforce initial staff education on electronic medication reconciliation.
Medication Safety Screensaver.
Guideline to Medication Reconciliation: Conducting Patient Interviews.
Example staff education materials that include staff instructions for reconciling medications at admission.
Example Process Flow Charts
- Luther Midelfort, Mayo Health System, Eau Claire, WI (PDF 13KB)
Medication reconciliation reviews may be conducted during the admission process, often by nurses on the admission unit, to identify unreconciled medications and potential errors or adverse events. This flowsheet helps nursing personnel perform a medication reconciliation process when patients are admitted to an intermediate care unit, either directly or as transfers from other inpatient care units.
- University of Massachusetts Memorial Medical Center, Worchester, MA (PDF 15KB)
Admission Medication Reconciliation Process for Elective Orthopedic and Emergent Medical through ED.
Medication reconciliation reviews may be conducted during the admission process, often by nurses on the admission unit, to identify unreconciled medications and potential errors or adverse events. This flowsheet helps nursing personnel perform a medication reconciliation process when patients are admitted to an intermediate care unit, either directly or as transfers from other inpatient care units.
Admission Medication Reconciliation Process for Elective Orthopedic and Emergent Medical through ED.
Admit Forms
- Grinnell Regional Medical Center, Grinnell, IA (PDF 16KB)
Medication reconciliation inpatient admission form.
- Guthrie County Hospital, Guthrie Center, IA (PDF 24KB)
A medication history form used on admission.
- Mercy Medical Center, Des Moines, IA (PDF 123KB)
A three page medication reconciliation/physician order form used on admission.
- University of Iowa Hospitals and Clinics, Iowa City, IA (PDF 50KB)
This one page form helps pharmacy personnel perform medication reconciliation on admission.
- Luther Midelfort, Mayo Health System, Eau Claire, WI (PDF 100KB)
This form aids nursing and pharmacy personnel in performing medication reconciliation when patients are admitted to an intermediate care unit, either directly or as transfers from other inpatient care units.
- Mercy Health System, Janesville, WI (PDF 38KB)
This one page form helps nursing personnel perform medication reconciliation on admission.
- South Carolina Hospital Association (PDF 28KB)
This is a one-page form that reconciles home [pre-admission] meds with admission meds; this version of the reconciliation form allows the MD to use the form to write admission medication orders.
- Winter Haven Hospital, Winter Haven, FL (PDF 51KB)
This form was developed to obtain a list of "medications as at home" prior to admission, and it has been used extensively in all outpatient areas and on a medical/surgical unit; developed by Winter Haven Hospital (Winter Haven, Florida, USA).
Medication reconciliation inpatient admission form.
A medication history form used on admission.
A three page medication reconciliation/physician order form used on admission.
This one page form helps pharmacy personnel perform medication reconciliation on admission.
This form aids nursing and pharmacy personnel in performing medication reconciliation when patients are admitted to an intermediate care unit, either directly or as transfers from other inpatient care units.
This one page form helps nursing personnel perform medication reconciliation on admission.
This is a one-page form that reconciles home [pre-admission] meds with admission meds; this version of the reconciliation form allows the MD to use the form to write admission medication orders.
This form was developed to obtain a list of "medications as at home" prior to admission, and it has been used extensively in all outpatient areas and on a medical/surgical unit; developed by Winter Haven Hospital (Winter Haven, Florida, USA).
Admit/Discharge Forms
- Buena Vista Regional Medical Center, Storm Lake, IA (PDF 22KB)
This one-page form was developed to aid in reconciling medications upon admission and on discharge.
- AnMed Health, SC (PDF 20KB)
This is a one-page form that reconciles home [pre-admission] meds with admission meds, and with discharge meds. The difference in this form and the standard Medication Reconciliation Form is that this one allows the MD to use the form to write discharge medication orders.
- United Hospital System, Kenosha WI (PDF 46KB)
A one-page form for admission and discharge reconciliation with a physician signature to verify review of discharge reconciliation.
- University of Massachusetts Memorial Medical Center, Worcester, MA (PDF 167KB)
This medication reconciliation order form can be used as a tool for reconciling medications at admission and discharge.
This one-page form was developed to aid in reconciling medications upon admission and on discharge.
This is a one-page form that reconciles home [pre-admission] meds with admission meds, and with discharge meds. The difference in this form and the standard Medication Reconciliation Form is that this one allows the MD to use the form to write discharge medication orders.
A one-page form for admission and discharge reconciliation with a physician signature to verify review of discharge reconciliation.
This medication reconciliation order form can be used as a tool for reconciling medications at admission and discharge.
Discharge Forms
Columbia St. Mary’s, WI (PDF 167KB)
A five-page electronic record discharge reconciliation/order form.
Transfer/Post-op Forms
Columbia St. Mary’s, WI (PDF 126KB)
A three-page electronic record transfer/post-op reconciliation/order form.
Ambulatory Forms
St. Mary’s Medical Center, Green Bay, WI (PDF 45KB)
A one-page admission/post-op/discharge reconciliation/order form.
Community
Medication Brochure and Wallet Card
Grinnell Regional Medical Center, Grinnell, IA
Questions every patient should ask.
Success Stories
Buena Vista Regional Medical Center, Storm Lake, IA
Guthrie County Hospital, Guthrie Center, IA
Regional Medical Center, Manchester, IA
100,000 Lives Campaign - Iowa Mentor Hospitals in Preventing Adverse Drug Events
Buena Vista Regional Medical Center, Storm Lake
Kossuth Regional Health Center, Algona, IA
St. Luke’s Hospital, Cedar Rapids
Resources
Articles