Medication Reconciliation Review

Guidelines:

• Complete medication history to be completed pre-operatively
• Communication with prescribing physician often required

Considerations:

• Medications often delayed
  • Aspirin/anticoagulants-risk for bleeding
  • NSAIDS-risk for bleeding
  • HTN medications- possibly held
  • Alcohol/drugs
  • Marijuana
  • OTC Herbs (St John’s Wort)

Nurse’s role:

• Ensure proper medication reconciliation is completed
• Patient interview to ensure compliance with medication instructions
• Facilitate conversation between surgical teams, anesthesia, primary care, etc

Pitfalls:

• No proper pre-op completed
• Patient knowledge deficit
• Different expectations between physician teams
• Family/caretaker involvement

Examples:

• Patient told to hold xarelto 7 days before procedure, reports she was told to never stop it by cardiologist
• Patient reports day of surgery that they took their long-acting insulin before reporting to pre-op

Linchpins (Key Points):

• Each patient will have specific parameters for medications to be held, given, etc.that is
  a unique risk/benefit conversation for that patient