Continuity of Care Patients 65 years and older have multiple medical problems, are on multiple medications, and are seen by multiple providers. Having a primary care physician, communicating among all providers, and reconciling medications are all essential for quality patient care. Ask the patient… 1. What are the names of the medications (including OTC, vitamins and herbal supplements) you are currently taking? 2. How do you take your medications and how much have you been taking? 3. Do you understand what the medication is for? 4. Where do you get your prescriptions filled? MD action… 1. Compare home list to the list in the patient’s chart. 2. Ensure dose and frequency are the same and there is a clear indication for every medication. 3. If patient doesn’t understand what meds are for, educate using plain, non-medical language; speak slowly; break down information into short statements. 4. Call the pharmacy if there is any discrepancy between the patients’ reported meds and your list. Rectify in the patient’s chart. Medication Reconciliation Steps References: Wenger, N.S. and R.T. Young (2007) “Quality Indicators for Continuity and Coordination of Care in Vulnerable Elders.” JAGS 55:S285-292. Varkey, P. et al (2007) “Improving Medication Reconciliation in the Outpatient Setting.” Jt. Comm J on Funding provided by D.W. Reynolds Foundation Obtain medication list from patient Obtain medical record medication and problem list Identify discrepancies Include updated list in clinic note Give patient a copy of updated medication list Document updated medication list Optimize the list Reconcile list Call pharmacy or call family Consolida te meds Incorpora te into med list Enumerat e all meds Evaluate ongoing need of each med.