Medication Reconciliation Assignment

Assignment

Overview:

This assignment is designed to help develop and demonstrate your skills in medication reconciliation, ensuring patient safety and continuity of care. In this assignment, you will be given a scenario and a patient that you will be “seeing” in the clinical setting. You will be reviewing that patient’s home medication list and comparing the list to your admission orders. After reviewing the two lists and taking a deep dive into the medications listed, you will create a list of recommendations to bring up with the patient’s Primary Healthcare Provider when they round on your patient for the day, addressing any missing medications or safety issues.

Scenario:

Mary Ann is a 68-year-old female with a past medical history of hypertension, hyperlipidemia, and Type II Diabetes. She also has chronic arthritic knee pain, which she manages with over-the-counter medications. She denies using alcohol and has no known allergies. She presented to the hospital with severe flank pain and had a CT scan of the abdomen with IV contrast, which showed a large left-sided kidney stone with ureteral obstruction. She is being admitted to the medical floor and will be having a lithotripsy in the morning.

Her blood pressure is 155/68, heart rate is 62, Temperature is 99.0, and respiratory rate is 20 and non-labored. She is alert and oriented, has a normal S1 & S2, and has no murmurs. She has clear lung sounds bilaterally. She has normal bowel sounds. Her extremities are warm with 2+ Radial and DP pulses. She has bilateral 2+ lower extremity edema. She is currently reporting an 8/10 pain in her left abdomen/flank area. She has a BMI of 38. She lives alone at home. Her husband died several years ago, and she has two daughters who live out of state. Her morning lab work showed abnormal values of a WBC count of 15,000, Creatinine of 2.4, and a glucose of 210. All other labs were normal.

Home medications:

• Aspirin 81 mg PO 1xD
• Metformin 500mg PO 2xD
• Lisinopril 40mg PO 1xD
• Metoprolol 50mg PO 2xD
• Ibuprofen 600mg PO q6h PRN
• Tylenol 500mg PO q6h PRN
• Atorvastatin 40mg PO 1xD taken in the evening
• Multivitamin PO 1xD

Inpatient medication orders:

• Aspirin 81 mg PO 1xD
• Metoprolol 75mg PO 2xD
• Tylenol 650mg PO Q6H PRN for mild pain 1-3 out of 10
• Atorvastatin 40mg PO 1xD QPM
• Humalog insulin sliding scale (SC) ACHS
• Glu<60 call provider
• Glu 61-150 No Coverage
• Glu 151-200 2 Units SC
• Glu 201-250 4 Units SC
• Glu 251-300 6 Units SC
• Glucose >300 call provider
• Heparin 5000 units Q8H SC
• Lasix 20mg PO 1xD

Assignment Tasks:

In an MS Word document, please complete the following tasks:

Section 1. Home Medication List Rationale:

In paragraph form, look at each medication on the home medication list and give a brief overview of each medication including the drug class, indication for administration (what medical diagnosis in the scenario is the drug treating specifically), safe dose range compared with current dose, basic medication administration details, most common and life-threatening side effects, and monitoring parameters (labs, vital signs, physical assessment findings, etc.) You should have at least 1 paragraph for each medication you are reviewing. All information in this paragraph should be cited with an appropriate reference (Nursing Drug Guide, Pharm/Med Surg Textbook, ATI Book, etc. – please do not use websites like drugs.com, WebMD, etc.)

Section 2. Hospital Medication List:

Your patient has been admitted to the hospital, and you have your inpatient admission medication orders. Review this list and, in paragraph form, answer the following questions.

Are there any home medications missing? If yes, do you think they were omitted for safety reasons? Vital sign abnormalities? Lab abnormalities? Or was it an accidental omission?

Are there any medications ordered that are not on the home medication list? If so, why do you think this medication was ordered? For new medications, give a medication overview similar to section 1, with a rationale for why the medications are ordered.

Are there any medications that are not on either list that you believe should be included on the patient’s medication list (PRN medications, prophylactic medications, etc).

Provide a rationale (with a cited resource) on how you support your information in this section.

Section 3. Compile a final medication list for the inpatient stay to recommend to the patient’s primary healthcare provider based on the first 2 sections. This section can just be a list of medications, similar to the ones you received in the initial scenario. Your rationale should be provided in the above sections.

Your paper should be written in the current APA format and have a title page, a body with the 3 sections above, and a reference page. Please make sure all references are cited appropriately within your paper. Please reach out to the writing center for assistance with APA format or completing the assignment if needed.

Medication Reconciliation Assignment Rubric

Medication Reconciliation Assignment Rubric

CriteriaRatingsPointsSection 1

—

A full overview is given for each medication on the home medication list, with a particular focus on patient safety.

25.1 to 40 pts

—

A partial overview is given for each medication on the home medication list, with a focus on patient safety.

10.1 to 25 pts

—

The review of medications is incomplete and lacking detail. Major safety information is missing from the overview. Or the assignment is not submitted on time.

0 to 10 pts

/40 pts

Section 2

—

A detailed overview of new medications on the hospital medication list is given. Missing medications are properly identified with a rationale for their omission with consideration for appropriateness of the medication use and a focus on patient safety.

15.1 to 30 pts

—

An overview of new medications on the hospital medication list is given, but some details are lacking. Missing medications are properly identified with a rationale for their omission with consideration for the appropriateness of the medication use. Some safety details are missing.

5.1 to 15 pts

—

The overview of new medications on the hospital medication list is lacking detail. Rationale for missing medications is sparse. There is a lack of consideration for patient safety shown.

0 to 5 pts

/30 pts

Section 3

—

A safe medication list is created considering the patient’s home medication list, inpatient hospital medication list, and physical exam findings reported in the scenario.

5.1 to 15 pts

—

There are major medications missing from the new mediation list that should be considered based on the scenario details.

0 to 5 pts

/15 pts

Grammar

—

There are little to no grammatical errors within the paper. The paper is written in full sentences/paragraph form without excessive medical jargon and abbreviations.

5.1 to 10 pts

—

There are a few grammatical errors which do not detract from the meaning of the paper. There is some use of medical jargon within the paper or abbreviations which are not defined before use.

0.1 to 5 pts

—

There are major grammatical errors within the paper that detract from the meaning of the paper. The paper is not written in full sentences/paragraph format and does not flow like a formal written paper.

0 to 0 pts

/10 pts

APA formatting

—

There are fewer than 3 APA formatting errors with appropriate citations throughout the paper.

3.1 to 5 pts

—

The paper contains 3-5 APA formatting errors with appropriate citations within the paper.

0.1 to 3 pts

—

There are more than 5 APA formatting errors or there is a lack of citations within the paper.

0 to 0 pts

/5 pts

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