Medication Reconciliation Simulation
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This teaching case has been used with 3rd and 4th year medical students to teach topics pertaining to medication reconciliation including safe and effective medication use.
A standardized patient, 3 faculty members, and an administrative assistant were used to accomplish the goals of this case. Specifically, a standardized patient interrupts a classroom session and asks for assistance in figuring out which medications she is taking. Furthermore, the patient wishes to know if her medications are responsible for the side effects she is experiencing. The standardized patient has some prescription vials, some drug samples, an incomplete medication list, a telephone number for her pharmacy, and a telephone number for her doctors’ office.
Students are tasked with telephoning the “pharmacy” and the “doctors’ office” and interviewing the patient, in conjunction with using the resources provided by the patient (incomplete medication list, prescription vials, and drug samples), to synthesize the patient’s medication list. By completing this exercise, students will simultaneously encounter patient- and systems- related difficulties that lead to medication-related problems (e.g. lack of communication between healthcare providers, poor communication between patient and provider, etc.), and they will evaluate the signs and symptoms with which a patient presents in the context of the medications she has been taking. Moreover, students will discuss whether the medications are appropriate for the medical conditions that the patient has. Furthermore, during the debriefing session, students will discuss each medication with the patient to educate and empower her to take a more active role in her own medication management.
Although we teach medical students the basic mechanisms of drugs in the early years of medical school, we must do a better job instructing students about safe and effective prescribing practices (AAMC, Report X) and the complexities of pharmacotherapy in actual patients.
Medication reconciliation has been a priority with the Institute of Medicine, Institute for Healthcare Improvement, and Joint Commission on Accreditation of Healthcare Organizations, but it is not just an “institutional” problem. Medication reconciliation is not simply about copying medications from one list to another; it is not a “computer” problem. Instead, medication reconciliation offers opportunities to assess appropriateness of each medication for individual patients by taking into account patient-specific parameters (e.g. comorbidities, diagnoses, financial considerations, etc). Even in outpatient settings, medication reconciliation can decrease medication errors, improve patient outcomes, and save healthcare costs.
This case illustrates complexities associated with medication reconciliation as students must use resources available to “solve the puzzle” of the medication regimen the patient is taking. In addition, students encounter patient- and systems- factors that impact appropriate medication utilization and safety. They also begin thinking about patients’ problem lists in terms of potential medication adverse events. Students begin to critically analyze the appropriateness of each medication that a patient is taking and develop a dialog with the patient to education him/her about the reason for each medication, common adverse effects, how to avoid problems, etc.
Students have rated this simulation session highly (>4 on a 5 point scale) in most areas assessed, and the majority of students (14 of 15; 93%) have indicated that the session is worth their time (additional details of effectiveness provided in Instructors’ Guide).
Karpa K. Medication reconciliation simulation. MedEdPORTAL Publications. 2012;8:9275. http://doi.org/10.15766/mep_2374-8265.9275
Contains Information Suitable for Patient Education
- To gather a medication history for a patient using available resources and synthesize an accurate medication list for a patient.
- To identify a patient’s chief complaint in the context of medication-related adverse effects.
- To discuss patient-specific and system factors that impact accurate medication utilization.
- To provide patient education for each drug on the medication list to empower patient’s involvement in care.
- Medication Reconciliation
This information is made available under the Creative Commons license.
Authors & Co-Authors
Kelly Karpa, PhD
Pennsylvania State University College of Medicine
Sponsorship or Funding Source
Woodward Endowment for Medical Sciences Education, Penn State University College of Medicine
Health Resources and Services Administration