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Table 2 MedRec Gaps at WDMH, FHT Ontario, Cornwall LTC, and local community pharmacy

From: Avoiding a Med-Wreck: a structured medication reconciliation framework and standardized auditing tool utilized to optimize patient safety and reallocate hospital resources

Gaps WDMH Cornwall LTC FHT Ontario Local community pharmacy
#1 Nurses are filling out the MedRec on admissions Patient’s own document sheet (PODS) not given to all patients Patients do not receive a complete list of medications from community pharmacy Lack of communication between hospital physician and community pharmacist
#2 BPMH are collected through single source instead of 2–3 sources to verify the information PODS not given to community pharmacies The discharge summary report has discrepancies Discharge report is missing information like limited use codes
#3 MedRec on transition of care is missed most of the time No information provided for where community pharmacies can contact to clarify discrepancies—most staff unwilling to help once patient is discharged Patients/caregivers are not interviewed often when obtaining a BPMH There are often discrepancies between medications prescribed by hospital physician and family physician
#4 MedRec on discharge do not include patient counseling points. Also, patient medication changes are not always given to patients upon discharge PODS not reviewed with patients BPMH is not commonly done proactively Lack of laboratory results hinders ability to monitor patients on new, changed medications
#5 Communicating the changes are not always shared with community pharmacist, long-term care facilities and family doctors Discharge prescriptions and PODS/summary of visit are not sent to the patient’s community pharmacy upon discharge   MedRec often not completed accurately. Patient medication list is often missing over-the-counter medications