Name of the Procedure:

Discharge medications reconciled with the current medication list in outpatient medical record (COA) (GER)

Summary

After being discharged from a healthcare facility, your medications are reviewed and compared with those you were taking before and during your stay. This ensures that your outpatient medical record is up-to-date, accurate, and reflects any changes in your treatment plan.

Purpose

This procedure is designed to ensure that patients have an accurate and consistent list of medications when transitioning out of a healthcare facility. This helps prevent medication errors, adverse drug interactions, and ensures continuity of care.

Indications

• Transition from inpatient to outpatient care
• Discharge following surgical procedures or hospital stays
• Patients with complex medication regimens
• Patients with chronic health conditions

Preparation

• Bring a current list of all medications, including over-the-counter drugs, supplements, and herbal remedies.
• If applicable, bring any medication containers or labels.
• Inform healthcare providers of any recent changes made by specialists or other healthcare professionals.

Procedure Description

1. Review: A healthcare provider, usually a nurse or pharmacist, will review all medications you were taking before admission, during your hospital stay, and those prescribed at discharge.
2. Comparison: This list will be compared against your outpatient medical record to identify any discrepancies or duplications.
3. Discussion: The healthcare provider discusses any changes with you, ensuring understanding and addressing any questions or concerns.
4. Update: The final reconciled list is updated in your outpatient medical record and a copy provided to you.

Tools: Electronic health records (EHR) for comparison; medication reconciliation forms; communication tools for multi-disciplinary discussions.

Duration

Typically takes about 20 to 30 minutes.

Setting

This procedure is typically performed in an outpatient clinic or before discharge from the inpatient setting.

Personnel

• Registered Nurse (RN)
• Clinical Pharmacist
• Possibly involving a physician or other prescribing healthcare providers

Risks and Complications

• Inaccurate medication list if not all information is provided.
• Potential for unrecognized drug interactions if the list is incomplete.
• Rare but possible human errors during the reconciliation process.

Benefits

• Improved patient safety by preventing medication errors.
• Enhanced understanding of treatment and subsequent adherence to medication regimens.
• Reduced likelihood of adverse drug reactions and hospital readmissions.

Recovery

No physical recovery needed, but patients should follow their updated medication plan and report any adverse effects or concerns immediately to their healthcare provider.

Alternatives

• Patients manually updating their medication lists, though this is less reliable.
• Utilizing digital apps or tools to track medications, but these are dependent on patient input.
• Regular follow-up appointments for ongoing medication review.

Patient Experience

During the procedure, you might feel reassured as your healthcare team carefully reviews and explains your medication plan. Afterward, you may feel more confident in managing your medications, understanding their purposes, and how to take them correctly. Pain and discomfort are not expected as it is a non-invasive process.