Unified Pharma Blogs

Posted on February 20, 2020

By Unified Pharma

Medication Management

Medication management is one of five key areas known to reduce avoidable readmissions. Hospitals working on this topic will focus on improving the use of medications for the patient’s condition and ensuring that the patient understands the purpose of the medications and is taking them in the correct manner at the correct time. Interventions may include medication reconciliation, patient/family education on medications, medication therapy management, and medication set-up simulations for the patient/family.

Medication Management – Tools and Resources >

Typical Transition Failures

Oversight of Medication List

  • Interaction of medications from multi-prescribers is not assessed
  • Medication list is incorrect
  • Inpatient list of medications is not accurate and patient is sent home with an incorrect list
  • EMR does not match what medications the patient is actually taking
  • There is no care provider assigned for accountability of the patient’s medications

Prescribed Medications

  • Chronic medications not adjusted for acute episode
  • Discharge medication orders are incorrect
  • Medication is not available to the patient due to formulary differences
  • Provider does not know if patient filled prescriptions


  • Lack of communication with care givers across the continuum of care
  • Medication list is not available to the next care provider
  • Next point of care provider does not have access to the previous care provider or records
  • Next point of care does not confirm receipt of information to previous care provider
  • Community pharmacies are not included as a care team member and do not receive information

Patient/Family Engagement

  • Lack of engagement of patient and/or family in the discharge plan
  • Understanding of patient’s ability to take medications not assessed
  • Family is not prepared or able to assist patient with the medications and their abilities not assessed
  • Patient fails teach back
  • Patient does not have resources to obtain medications after discharge
  • Patient does not understand new medications and continues to take old medications

Best Practices/Strategies for Improvement

  • Assess patient’s knowledge of medications on admission, using Teach Back and communicate this information with other care providers and include in the care plan. Information from the assessment is put into the care plan and action is taken to resolve issues
  • Reconcile medications on admission with input from patient and family
  • Medications ordered for patient during hospitalization are compared to the medication list obtained on admission to assure chronic medications are given during hospitalization
  • Discrepancies such as omission, duplications, adjustments, deletions, additions are resolved during the hospitalization
  • On transition the patient’s most current reconciled medication list is provided to the next care provider
  • On transition, the sending organization informs the next provider how to obtain medication clarification
  • The patient receives comprehensive medication education and patient level of understanding is assessed through teach back
  • A written listing of medications is provided to the patient and family upon transition including the name of the medication, the dose, the route, the purpose, side effects and special considerations in language that is easy to understand for the patient
  • For patients with complicated medication regimes, pharmacy may perform patient education, medication review, follow-up phone calls, in-home visits
  • For patients with complex medications refer for Medication Therapy Management and have available both in the in-patient and outpatient setting

Potential Process Measures

  1. Patient’s ability to name medications, their purpose, how and when to take them and any special precautions is documented in the record
  2. Patient’s ability or inability to name medications, their purpose, how and when to take them and any special precautions is communicated to the next care provider
  3. If the patient is unable to name medications, their purpose, how and when to take them and any special precautions a plan of care for medication management is developed with the patient and family is documented and communicated to next care provider and followed up after transfer
  4. Patients with more than five prescribed medications or more than two medication changes during hospitalization are referred for follow-up/ pharmacy/ medication management
  5. Medication list is up to date and is reconciled on each transfer

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