Procedure Logs

C3.2 R5: Reconcile a patient’s medications on ADMISSION

TP is a 13 year old girl who had a suicide attempt with a history of dyslipidemia secondary to quetiapine XR use for intermittent explosive disorder, disruptive mood dysregulation disorder and identity disorder. Questions at rounds had been raised around timing of medications (in relation to what patient described taking and what was on the admission med reconciliation form). I completed a reconciliation on admission by speaking with patient’s mother (over the phone) and the patient’s pharmacy. This allowed us to provide the patient with the correct medication and administration of her meds on this admission. I used this opportunity of contacting the mom and pharmacy to inquire about the patient’s third party plan for future planning for med changes.

I wrote the following note in the chart:

DATE, TIME

Clinical Pharmacist’s Note re: confirmation of medication reconciliation

Questions at rounds had been raised around timing of medications (in relation to what patient described taking and what was on the admission med reconciliation form). Spoke with mom who was very aware of her daughter’s medications.

Drug Dose Notes from mom 
Metformin 1000 mg PO BID They were told that they do not need to do any blood glucose testing. Confirmed that she is to take BID dosing.
Quetiapine 200 mg XR PO in the evening Mom aims to administer this earlier in the evening, but usually is given with melatonin at 8 pm. Dose was recently increased two weeks ago from 150 mg, no differences reported by mom thus far.
Clonidine STOPPED (confirmed) Was given to her a year ago to help with sleep (along with quetiapine and melatonin) but was not found to be efficacious
Melatonin 15 mg PO at bedtime Taken at 8 pm

Mom expressed no concerns re: medications at this time.

  • Iona Berger, BScPharm
  • Pharmacy Resident

 

Thanks Dean for allowing me to submit yet another procedure log! I am happy to report this is my LAST procedure log *insert all the celebratory emojis here.*  I didn’t quite meet my goal of finishing them before the start of 2017…but I was close enough.

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