Primary Care MedRec Guide

Medication reconciliation (also known as "MedRec") is a patient safety intervention that was introduced to improve communication about patients' medication information as they transition through the healthcare system. It is targeted at both the patient and the patient's healthcare providers and is designed to help prevent adverse drug events. The need for effective MedRec processes has been well established. Without effective processes in place, failures in communication about a patient's medications can result in harm to the patient, can unnecessarily burden the healthcare system, and can affect society at large.

MedRec processes should be implemented within each healthcare sector, but for this intervention to be most effective, linkages across sectors are needed. The primary care sector has a pivotal role in creating these linkages. Primary care is often the setting where patients receive most of their healthcare, and it often functions as the coordinating centre for the rest of the patient's care. Developing implementation strategies, leveraging available resources, and identifying and overcoming barriers can assist with establishing MedRec in primary care.

Completing MedRec in primary care involves 4 main activities:

• Collecting and documenting an accurate and up-to-date medication list (the Best Possible Medication History [BPMH])
• Comparing the BPMH with information in the patient's chart and identifying discrepancies (i.e., differences between various sources of medication information)
• Correcting the discrepancies as appropriate through discussion with the primary care provider and the patient and then updating the BPMH with the resolved discrepancies, thereby creating a reconciled list
• Communicating the resulting medication changes to the patient and verifying the patient's understanding of his or her medication regimen

To implement MedRec reliably and consistently within a particular primary care setting, the roles and responsibilities of each team member should be established early on. In rare circumstances, MedRec is carried out by one individual, but the process generally requires input from various members of the healthcare team. Integral to the process is the patient. The patient or the patient's caregiver is best positioned to accurately convey exactly how the person takes his or her medications in the home environment. Ascertaining actual medication use from the patient is the most crucial step of the MedRec process.

Several sources of medication information are available for use in creating a comprehensive medication list. These sources often do not contain all the necessary information; for example, they may not include vitamins, supplements, and nonprescription medications. However, they can serve as a starting point in obtaining the BPMH. The information collected from these sources must then be verified with the patient to confirm actual medication use.

Establishing effective MedRec processes in the primary care sector can be particularly challenging. Many primary care providers do not have the infrastructure supports, time, or resources necessary to complete this complex intervention. However, MedRec can usually be introduced into a practice setting in a phased approach, which may help to integrate the new workflow into existing processes at the practice site without overwhelming the team or disrupting processes that are already functioning well. For example, focusing initial efforts on high-risk patients (e.g., those recently discharged from hospital or those who are taking a high number of medications) may be a worthwhile approach.

Within the primary care sector in Ontario, many different players provide healthcare. Understanding their unique contributions and the outputs of their respective MedRec processes can make the process smoother for everyone. For example, the community pharmacist can assist by performing a comprehensive medication review (i.e., MedsCheck) with the patient and documenting all prescription and nonprescription medications that the patient is taking. At a minimum, the community pharmacist should be able to provide a printout of all medications dispensed at that particular pharmacy.

This guide, developed through consultation with an advisory committee and expert panel, is directed toward healthcare practitioners working in primary care. It provides an overview of MedRec as a system-integration intervention, describes the benefits of MedRec in reducing potential adverse events, and outlines strategies for implementing MedRec in a variety of primary care practice settings.