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