It is important for outpatient areas of hospitals and hospital-based clinics (such as outpatient surgery, dialysis facilities, outpatient oncology clinics, and family practice areas) to reconcile medications at each visit.
The process for reconciling medications in outpatient settings (including the Emergency Department for patients who are not admitted) is a bit different than the process for inpatient transitions.
First, a medication list must be collected. It is important to know what medications the patient has been taking or receiving prior to the outpatient visit in order to provide quality care. This applies regardless of the setting from which the patient came — home, long-term care, assisted living, etc.
The medication list should include all medications (prescriptions, over-the-counter, herbals, supplements, etc.) with dose, frequency, route, and reason for taking it. It is also important to verify whether the patient is actually taking the medication as prescribed or instructed, as sometimes this is not the case.
At the end of the outpatient visit, a clinician needs to verify two questions:
- Based on what occurred in the visit, should any medication that the patient was taking or receiving prior to the visit be discontinued, altered, or held pending consultation with the prescriber? [NOTE: This does not suggest that the clinician should verify the appropriateness of the medications or dosages, as that should already have been determined by the prescriber (who may also be in the most appropriate specialty to make this determination). The clinician in the outpatient setting only needs to determine whether something should be changed or held as a result of the visit or procedure — and this might be done in consultation with the original prescriber.
- Have any new prescriptions been added today?
These questions should be reviewed by the physician who completed the procedure when one occurs, or the physician who evaluated and treated the patient.
If the answer to both questions is “no,” the process is complete.
If the answer to either question is “yes,” the patient needs to receive clear instructions about what to do — all changes, holds, and discontinuations of medications should be specifically noted. Include any follow-up required, such as calling or making appointments with other practitioners and a timeframe for doing so.
When patients are recurring outpatients, a medication list can be kept on file rather than re-created on every visit. Each time the patient comes for a visit, the list should be verified again for any additions, deletions or changes to medications, doses, frequencies, routes and alterations from original prescription or instructions.