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Was an accurate BPMH obtained on admission?
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Was an accurate BPMH obtained on internal transfer? (If N/A = score of 1)
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Was an accurate BPMH documented at discharge?
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Were discrepancies between BPMH and medication administration record (MAR) record identified and resolved within 24 h of admission?
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Were discrepancies between BPMH and MAR identified and resolved at discharge?
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Were formulary/non-formulary auto-substitutions in the hospital reverted to what the patient was taking prior hospitalization? (If N/A = score of 1)
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Was a standardized discharge report (i.e., new, continued, stopped, and/or changed medications) faxed to the patient’s primary pharmacy?
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Did the patient receive a PODS at discharge?
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Was the patient counselled by pharmacist on all medications (including monitoring) at discharge?
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Was cost of medications and insurance coverage discussed and addressed with the patient?
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Is there a mechanism of communication between community pharmacist, family physician, and hospital physician?
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MedRec Score (out of 11)
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