ISMP Medication Reconciliation 2 — Questions and Answers
Question 1: ISMP recommends that the discharge medication list provided to patients include which critical element?
- Physician's billing codes
- Why each medication is being taken (indication) (Correct answer)
- Hospital room number
- Insurance co-pay amounts
Correct answer: Why each medication is being taken (indication)
Including the indication for each medication on the discharge list helps patients understand their treatment and recognize if a medication is missing or wrong.
Question 2: Which healthcare professional does ISMP identify as having a key leadership role in medication reconciliation processes?
- Hospital administrator
- Pharmacist (Correct answer)
- Dietary staff
- Physical therapist
Correct answer: Pharmacist
Pharmacists are identified by ISMP as having a key role in leading medication reconciliation due to their expertise in drug therapy and medication history taking.
Question 3: An 'unintentional discrepancy' in medication reconciliation refers to:
- A deliberate dosage change by the physician
- A difference in the medication list that was not intended and was not documented as a clinical decision (Correct answer)
- A generic substitution
- A brand-name preference
Correct answer: A difference in the medication list that was not intended and was not documented as a clinical decision
Unintentional discrepancies are inadvertent omissions, additions, or dose changes that occurred without a deliberate clinical decision, representing true errors.
Question 4: Which ISMP-recommended practice helps ensure medication reconciliation accuracy when a patient cannot communicate their medication history?
- Assume the patient takes no medications
- Contact the patient's pharmacy, caregivers, and prior healthcare providers (Correct answer)
- Wait for the patient to recover before reconciling
- Order all medications from scratch
Correct answer: Contact the patient's pharmacy, caregivers, and prior healthcare providers
When patients cannot provide their own history, ISMP recommends contacting pharmacies, family caregivers, and prior providers to obtain a complete medication list.
Question 5: ISMP has noted that electronic health records (EHRs) can both improve and create risks for medication reconciliation because:
- EHRs are always accurate and need no verification
- Copy-forward of outdated medication lists and alert fatigue can introduce or perpetuate errors (Correct answer)
- EHRs eliminate the need for pharmacist review
- All EHRs share data perfectly between facilities
Correct answer: Copy-forward of outdated medication lists and alert fatigue can introduce or perpetuate errors
EHR features like 'copy forward' can perpetuate outdated or incorrect medication lists, and excessive alerts can lead to alert fatigue, reducing reconciliation accuracy.
Question 6: According to ISMP, high-risk patients for medication reconciliation errors include those with:
- One chronic condition only
- Multiple chronic conditions, multiple prescribers, and complex medication regimens (Correct answer)
- No prescription medications
- Only topical medications
Correct answer: Multiple chronic conditions, multiple prescribers, and complex medication regimens
Patients with multiple conditions, multiple prescribers, and complex regimens face the highest risk because their medication lists are longer and more prone to reconciliation errors.
ISMP Medication Reconciliation 2
ISMP recommends that the discharge medication list provided to patients include which critical element?