Medication Reconciliation for Outpatients

Is it necessary to complete medication reconciliation forms for outpatients such as cystoscopies and carpal tunnels?

NPSG states that healthcare organizations must accurately and completely reconcile medications across the continuum of care.  This means that medication reconciliation must be completed for inpatients and outpatients as applicable.

A full medication reconciliation is not required for those outpatient procedures that involve minimal medication use and do not include discharge prescriptions or any other changes in medications that the patient has been taking.  Examples of minimal medication use are when local anesthesia is used when suturing lacerations or enteric barium for imaging studies.  In these examples a list of the patient's current medications and allergies/sensitivities must be obtained in order to make an informed decision regarding the use of "minimal medications", i.e., Will the local anesthesia used for suturing a laceration interact with the patient's current medications?  Does the patient have an allergy to the intended local anesthesia?

Medication reconciliation should be performed when any medication will be administered or prescribed for the patient or the risk or results of a procedure could be affected by certain medications.

Outpatient areas where medication reconciliation should be performed include the GI laboratory, outpatient oncology services, certain imaging procedures, i.e., x-ray with contrast media, outpatient surgery and at the time of discharge.

Medication reconciliation at the time of discharge avoids therapeutic duplication, drug interactions and omissions of medications that may have been discontinued or placed on hold during the patient's outpatient visit.

Medication reconciliation shall be performed at the time of outpatient discharge if:

  • Any prior medications that the patient was taking are discontinued or changed
  • Any prior medications should be held pending consultation with the prescriber
  • The patient receives any new prescriptions at the outpatient visit

Medication reconciliation does not need to be performed for outpatients presenting to the facility for physical therapy, laboratory services or routine imaging services, as long as a medication will not be administered or prescribed for the patient or the risk or results of the procedure could not be affected by certain medications

Clinics that see patients on a regular basis:

  •  After the initial list of the patient's current medications are completed on subsequent visits, the list shall be verified for any additions, deletions or changes to medications, doses and frequencies from the original instructions or prescriptions.  When new medications are ordered, those medications will be added to the list.  The list will be given to the patient at the end of the visit and the list will be communicated to other providers who are currently caring for the patient.
  • Providers are not required to approve or reorder a patient's current medical regimen.  Providers shall ensure that any new prescriptions do not duplicate the patient's current medications or present a potential interaction.

Discharge reconciliation or transmission of the list to the next provider is not necessary if the following conditions are met:

  • The "minimal medication use" occurs during a brief outpatient encounter
  • The medication acts locally with little systemic effect
  • An LIP administers the medication or its use has been reviewed by a pharmacist before administering the medication to the patient
  • No other medications are used during the outpatient visit or prescribed for or provided to the patient for use after discharge
  • The patient's current medications do not change
  • The next provider of care already has the patient's current medication and allergy information
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