Phelps County

1. Electronic Medication
Reconciliation
Phelps County Regional Medical Center
Karen Clover, BSN, RN
Pam Karr, MSN, RN-BC

2. Patient’s Presentation
 Patient presents to the ED
 Nurse obtains current medication list
Available for viewing by ED physician

3.  Screen shot of what nurses review on
admission

5.  Screen shot of ED med list

6. Patient admitted to facility
 Patient arrives to floor
 Nurse reviews previous med list and
confirms accuracy

7. Physician Reconciliation
 Screen shot

8. Patient transferred within
facility
 Screen shot of physician’s med rec with
transfer

9. Discharge
 Physician screen shot of d/c med rec

10. Phelps County Regional Medical Center
Discharge Medication List / Discharge instructions
Patient Name: Patient Joe Report Status: Signed
Account Number: Report Number: 0525-0024
Attending Physician:
PLEASE KEEP THIS LIST BRING IT WITH YOU IF/WHEN YOU MUST RETURN TO T
***NOTE: Patients and families are reminded to discard old lists and to update any records with all medication p
Discharge Instructions
ALLERGIES
Coded Allergies:
IVP Dye (Severe, ANAPHYLAXIS 04/01/11) Penicillin's (05/17/11)
PRESCRIPTIONS
Continue taking these medications:
Norvasc (Amlodipine Besylate) 10 MG TAB 10 MILLIGRAM ORAL Daily
Prilosec (Omeprazole) 20 MG CAPDR 20 MILLIGRAM ORAL Daily
Synthroid (Levothyroxine Sodium) 75 MCG TAB 75 MICROGRAM ORAL Daily
Caltrate-600 With Vit D Tab (Calcium Carb/Vit D3/Minerals) 1 TAB TABLET 1 TAB ORAL Daily
Omega 3 Fish Oil 1,000 Mg Cap (Omega-3 Fatty Acids/Fish Oil) 1 CAP CAPSULE 1 CAPSULE ORAL Two Times A Day
Tylenol (Acetaminophen) 325 MG TAB 650 MILLIGRAM ORAL Q6H PRN
:
Start taking the following new medications
Vicodin 5 Mg/500 Mg (Hydrocodone-Apap 5 Mg/500 Mg) 1 TAB TAB 1 - 2 TAB ORAL As Needed
Discharge Instructions DIET: Regular
DIET RESTRICTIONS: None
SPECIAL INSTRUCTIONS: None
WOUND/SKIN CARE: [may shower in the am]
ACTIVITY RESTRICTION: no lifting over 20 pounds for two weeks
FOLLOW-UP CARE: Follow up with Dr. Wilcox in 10 days

11. Challenges
 Patient’s ability to recall medications,
dosage, and frequency
 Interviewer’s skill level
 Time constraints
 Accessibility during nights/weekends for
confirmation of med list
 Multiple Providers

12. Challenges
 Language barriers/cultural beliefs
 Stress of transitioning through
healthcare system
 Accuracy and completeness of medical
history obtained from other resources
 Communication of incomplete home
medication list

14. Newest Challenge
 Transitioning to paperless electronic
record
 Complexity of electronic health record
 Compliance with provider to use
electronic medication reconciliation
 Efficient up dating of medication record