Welcome to the resource page for admission medication reconciliation. Below you will find helpful tools to successfully complete your inpatient admission medication reconciliation rotations at The Ohio State University Wexner Medical Center.
Standard Operating Procedure
This is your primary reference for how to access and document information in IHIS.
Quick Start Guide
Having trouble getting started? Need a Fax Number or NPI number? Refer to this quick start guide.
Communication Overview
For information on how to conduct a pharmacy, patient, and patient family/contact interview, refer here.
Writing a Progress Note
Refer here for overview on writing an admission med rec progress note; sample note included at the bottom.
Special Populations
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Trauma Patients
- Trauma patients are named based on an alphabet system (e.g., UHETrauma Xray, UHETrauma Welcome, Emergent Delaware, Emergent Kansas, etc.).
- The patients real name and alternate MRN number may be listed in a social work/case management note, or in the Rx Handoff Sticky Note.
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Veterans Affairs
- Refer to the Admission Medication History and Reconciliation Standard Operation Procedure.
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Ohio Department of Rehabilitation and Correction (ODRC)
- Refer to the Admission Medication History and Reconciliation Standard Operating Procedure.
- ODRC (prison patients) are often denoted as “*************” rather than a patient name in IHIS.
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Patients From a Facility (Skilled Nursing Facility, Long Term Acute Care Hospital, etc.)
- If a patient came from a facility in which they reside (home for the patient), you will need to obtain the patient’s medication administration record (MAR).
- Check the Media Tab (Chart Review > Media Tab) to see if the MAR from the facility has been uploaded into the patient’s chart.
- For some facilitates (e.g., Select), you may be able to view the MAR in Care Everywhere (Care Everywhere > click on “Documents” > click on the admission document for the facility > click “Jump to Section” and select “Active and Recently Administered Medications”.
- Check the nurses station and UCA desk for a packet of information that came with the patient on transfer from the facility.
- If unable to obtain the MAR from the previous options, contact that facility and ask for them to fax over the patient’s medication administration record.
- Update the home medication list to match the medication administration record from the facility in which the patient lives.
- You may be able to find the name of the patient’s facility in a social work/case management note, or in the Rx Handoff Sticky Note. You may also ask the patient/family.
- If a patient came from a facility in which they reside (home for the patient), you will need to obtain the patient’s medication administration record (MAR).
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Dialysis Patients
- Call the patient’s outpatient dialysis center and verify the patient’s scheduled and obtain a list of medication that the patient received before/during/after dialysis.
- You may be able to find the name of the patient’s outpatient dialysis center in a nephrology note, case management note, or in the Rx Handoff Sticky Note. You mayalso ask the patient/family.
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Non-English Speaking Patient