Primary Care MedRec Guide

Many healthcare organizations and regulatory bodies support the involvement of their members as essential players in the MedRec process:

• Canadian Medical Protective Association: Action for Safer Medical Care: Medication Reconciliation
• College of Nurses of Ontario: Practice Standards: Medication
• National Association of Pharmacy Regulatory Authorities: Model Standards of Practice for Canadian Pharmacists
• Ontario College of Pharmacists: Best Possible Medication History Guidelines for Medication Reconciliation
• Registered Nurses' Association of Ontario: Best Practice Guidelines — Care Transitions

Below describes how various players can contribute to or be involved with performing MedRec.

The patient and/or their primary caregiver are vital in the MedRec process. To ascertain an accurate and complete BPMH, that clearly captures actual medication use by the patient, an interview with the patient and/or their caregiver must occur.

It is also critical to ensure that the patient and caregiver are given appropriate information and education about any new medications prescribed, any changes to existing medications, and the reasons for discontinuing any medications. A valuable strategy in verifying patients' understanding of the medical information they have been given is to use the 'teach-back' method, (refer to teachbacktraining.org for more information).

Patients should be encouraged to record their own medication information and should be given appropriate tools to do so. They should be informed of the importance of documenting all medications that they are taking (including prescription and nonprescription medications, vitamins, and natural products) and to record actual medication use if it is different from prescribed use. The importance of communicating the up-to-date medication list with all members of the healthcare team should also be conveyed to patients. (Refer to Appendix 4 for a list of patient resources)

The primary care provider is an essential player in completing MedRec and may have several roles in the MedRec process. This person can be involved in interviewing the patient and collecting the BPMH, can assist in identifying and resolving discrepancies, and/or can communicate to the patient and other relevant players any changes that have been made to the patient's medication regimen.

Ideally, however, the primary care provider will not be involved in all aspects of the MedRec process but instead will focus on certain key aspects, as noted above, relying on other team members for other aspects of the process.

The primary care provider can also act as the patient's coordinator of care, helping the patient to compile and interpret treatment decisions made during a hospital stay, as well as decisions made by specialists and by others caring for the patient.

Much evidence suggests that the involvement of a pharmacist has a positive impact on the MedRec process.^{26, 29-31} As a member of a healthcare team or a team of care providers in another primary care practice setting, a pharmacist can complete many aspects of the MedRec process. Pharmacists are well suited to interview patients and collect BPMHs, identify discrepancies and initiate their resolution, communicate to patients any changes to their medication regimens, and provide education to patients about their medication regimens.

As a member of a health team or a team of care providers in another primary care practice setting, a nurse can initiate the MedRec process. Nurses can interview patients and collect BPMHs, identify discrepancies, and communicate to patients any changes made to their medication regimens.

The community pharmacist can assist with the MedRec process by completing a comprehensive medication review (i.e., MedsCheck, if the patient is eligible), including an interview and documentation of all medications that the patient is taking. During this process, the community pharmacist can also communicate to the primary care provider any discrepancies identified.

If a comprehensive medication review is not completed (e.g., patient is not eligible for MedsCheck or review is not required at the time), the community pharmacist can provide a list of medications that have been dispensed for the patient from that particular pharmacy, to assist with the MedRec process. However, such a list will not include medications dispensed at other pharmacies, over-the-counter medications, natural products, etc.

The administrative assistant in a primary care setting can assist with the MedRec process by reminding patients ahead of their scheduled appointments to bring in their medications and/or up-to-date medication lists. The assistant can also ask patients who are waiting for their appointments to check the current medication list on file and to identify any changes in their regimens. Finally, the assistant can help to identify patients that would be appropriate for MedRec.