Define medication reconciliation

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Reference no: EM133879326

Question

Mr. Salazar is an 88-year-old male admitted 13 days ago to the hospital for shortness of breath and back pain. His past medical history includes a 40-year smoking history, quitting at the age of 65 and an allergy to NSAIDs. His surgical history includes coronary artery bypass graft (CABG) at age 62. On admission, his medications included warfarin and a beta-blocker. Before this hospitalization, he was living independently with his 83-year-old wife of 20 years.

Diagnostic testing revealed Mr. Salazar has inoperable Stage 4 lung cancer with bone metastasis. No other treatment options are available. The treatment team discussed with Mr. Salazar and his wife palliative care options. Mr. Salazar's advanced directives were also reviewed and validated that his choice for palliative care was in alignment with his medical and end-of-life choices.

Mr. Salazar is not ready for transfer to an inpatient hospice facility for palliative and end-of-life care. His current treatment orders include comfort measures only, DNR, DNI, and no artificial nutrition (gastric tubes) or hydration (IVs). His level of alertness is quickly deteriorating and he is only oriented to person. He has also physically deteriorated and requires a 1-2-person heavy assist for transfer to bedside commode. His pain is being managed with Morphine 7mg every 4 hours and he is being turned and repositioned with pillows and other body props as needed to keep him comfortable. These help to alleviate pain and keep him at about a pain scale of 3. His skin is intact; however, he is starting to redden on the left shoulder; he prefers to lay on his left side. Liquids and pureed food are as tolerated; however, he is not requesting much other than his favorite "shake" which is 30 ounces of pureed apples. His wife remains by his side as well as their two adult children and several grandchildren. He enjoys listening to the television play Andy Griffith or music by Tony Bennett. He has requested that his family remain with him during his last hours. He is also having daily visits with the priest from his local Catholic church. He finds comfort in spiritual support.

Refer to the NLC Care Coordination Tool for Transition to Long-Term and Post-Acute Care document and MATCH toolkit when answering the following questions.

1. Based on the above case, what elements from Mr. S's personal, medical, surgical, and hospitalization history should be communicated at the time of care transition?

2. Based on the above elements identified, what specific details should be communicated about Mr. S at the time of transition?

3. Care coordination that includes input from a patient's medical team, caregivers, family, and spiritual leaders will help ensure quality end-of-life care. If the information is not communicated at the time of transition in a summary of care document what type of adverse events could occur?

4. Define medication reconciliation.

5. Why is the medication reconciliation process important at all transition points?

6. Is there information regarding Mr. S's medication regimen that would be important to clarify?

Reference no: EM133879326

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