HOW TO COMPLETE ACUTE MEDICATION RECONCILIATION ON TRANSFER ORDERS

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How to Complete Medication Reconciliation on Transfer Orders (MRTO)

How to Complete Acute Medication Reconciliation on Transfer Orders (MRTO)

Find the printed MRTO in the patient’s chart. It is usually clipped to the front or is filed under “Prescriber’s Orders” tab.

HOW TO COMPLETE ACUTE MEDICATION RECONCILIATION ON TRANSFER ORDERS

“STEP 1” on the MRTO: Locate the Admission Medication Reconciliation Orders (MRO) that were completed on admission.

**The MRO should be kept behind a blue “Medication Reconciliation” tab in the patient’s chart**

Review the Best Possible Medication History (BPMH) documented on MRO. Assess the medications that were held or discontinued. Medications that were held or discontinued on admission will not show up on the MRTO. Assess whether these medications should be restarted/adjusted now that patient is post-op. Document your decision(s) on the MRTO under “Additional Medication Orders”.

E.g. Warfarin was held on admission for inpatient anticipating OR. Now that patient is post-op, instead of heparin, patient should be re-started on at-home dose of warfarin.

Document any additional/new medications on the MRTO under “Additional Medication Orders”.
If additional space or pages are required, print a blank form (Form number: PHC-PH614 Acute Medication Transfer Order) from Chartscan on SCM for your orders.
Check off box on far right on MRTO to document that “Step One: Reassess Admission Medication Reconciliation Orders” is complete.

“STEP 2” on the MRTO: Reassess patient’s VTE risk according to the regional VTE risk assessment and thromboprophylaxis recommendation (printed on back of VTE PPO PHC-PH408).

Check off box on far right on MRTO to document the current assessed VTE risk for the patient. “Step 2: Reassess VTE risk” is complete.

“STEP 3” on the MRTO: Assess all medications on the MRTO.

Indicate beside each medication whether you would like to “yes” continue, “no” discontinue or “change” the medication order.
If changing an order, please indicate under the appropriate column what the new dose, frequency and direction should be.
If changing the stop date of a medication, please indicate under the appropriate column on the far right when the new stop date is.If there are conflicting or duplicate orders on the MRTO and PPOs, cross off the particular order on the MRTO and write under the “New Dose/ Directions” column “see PPO”. If the order on the MRTO is the desired order, then complete the MRTO order and cross off the other order on the PPO.
Ensure that each page of the MRTO is signed, dated and TIMED appropriately

**NOTE – Medications such as heparin and antibiotics have Automatic Stop Orders (ASOs). If you tick “Yes” on the MRTO to continue a medication order, the order continues until the stop date, e.g. if an antibiotic is due to stop tomorrow, the order will not be renewed and will stop tomorrow. If you want to extend the stop date of an order, indicate the new duration or stop date in the column on the far right of the MRTO.

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Tags: acute medication, phc-ph614 acute, orders, acute, transfer, medication, reconciliation, complete