MedRec in Home Care

Hi Lisa!

Thanks for sharing the various tools/forms used in the process and description of the process. So wonderful to see involvement of pharmacists in the MedRec process.

Are community pharmacists in general accepting orders on the letter, although not truly on a prescription form? Did you have to go through your governing body (i.e. the College of Pharmacy) for approval?

Thanks again,
Beatrice

Thanks for your interest.

We did a presentation with ISMP Canada to share our success. Screen shots are starting on page 20 of this presentation found at
www.ismp-canada.org/download/MedRec/EN_CCAC_Success_Story.pdf

This program also was recognized in CHI momentum challenge back in 2012. See this video - near the end it contains a screen shot of the MD letter template. imaginenationchallenge.ca/team/central-community-care-access-centre/

I have updated a version that my team used to communicate medication issues to the prescriber. Issues on the right side, recommendation on the left. The prescriber just had to tick off their choices or specify other orders. Sign and fax back. We took care of the rest.
Unfortunately it was still paper/fax based. Would love to be able to integrate this type of communication into the EMR.

Example of letter to communicate medication discrepancies to MD

Appreciate your thoughts.
Lisa

I would love to see these documents too.

Hi Lisa
I'd love to see the documents you are using. Can you share?
Thanks
Kim

Hi Beatrice,
I just wanted to weigh in on documenting and clarifying medication discrepancies in home care.

My team used a database (home grown) to help the nurses and pharmacists document:
1. Medication Inventory (our BPMH - illustrating actual use)
2. Assessment summary - documentation of problems identified, teaching done, person to resolve etc.
3. MD letter template - easy to read letter, with the key information that required prescriber input - two columns (issues / recommendations) - we would list discrepancies identified under issues - then under the recommendations list we put potential solutions - the prescriber would check off what they wanted or write in an alternative solution. In our recommendation line we would put a Mitte: _________ Repeats: ________ to be filled out if it would require a new Rx.
4. Medication Schedule - copied over from Med Inventory, easy to read for patients, could sort the order of the medication entries. Sent to the prescriber with the above letter. Once response received, it was updated to incorporate changes - appt made to followup with pt to provide copy and provide education.
5. Tracking sheets - for outcomes measures

We had great success using this format. Our MD response rate was over 80%.
They would fill out our form and fax back. Sometimes the MD's would include a separate prescription. We would fax to their community pharmacist.
Some pharmacies would accept the letter, adapt prescriptions as indicated - no problems.
Some pharmacist would refuse to acknowledge the documentation because it did not come directly to their pharmacies from the prescriber (a legislative requirement in Ontario). With those pharmacists, we asked that they contact the prescriber office directly to get confirmation.

Once our reconciled list was complete, this database made it easy to submit our documents to our home care agency as well as forward an updated list to specialists, nursing agencies and other involved in the care of the patient.

I can e-mail you a copy of the MD letter template if you like. Let me know.

Lisa

If this URL doesn't work (www.ismp-canada.org/download/MedRec/HomeCare/Saskatoon%20_MedRec_Physician_Order_Form.pdf), here are the directions!
Go to the "National" tab on ISMP's main page, then "Home Care" then 1st bullet is the Med Rec Getting Started Kit & the last sub-bullet under there is a copy of SHR's Home Care BPMH/Med Rec Version 28 form. We have made a couple subtle changes since. That we have had 30 revisions in 10 years speaks to the fact that this continues to be a work in progress!