Medication Reconciliation

This subject guide provides medication reconciliation education and support to Nova Scotia Health staff and physicians involved in medication management throughout all transitions of patient care.

Nova Scotia Health Learning Modules

This course is available on the Provincial Learning Management System (LMS).

  • Medication Reconciliation Series Module 1: Basics

Best Possible Medication History Interview Guide

Completion of a Medication Reconciliation Via Phone or Zoom

If a patient requires a Best Possible Medication History (BPMH) and/or a Medication Reconciliation (Med Rec) and cannot meet in person, the BPMH/Med Rec can be completed by phone or by a Nova Scotia Health-approved video chat method (i.e. Zoom for Healthcare).

To complete a BPMH and/or Med Rec:

1. Prepare the patient/caregiver

  • Work with the patient/family/caregiver explain your role and the purpose of medication reconciliation. Determine who you should speak with regarding the patient’s home medications.
  • Ask if the patient/family/caregiver if they are willing to meet by phone or video chat using a Nova Scotia Health-approved video chat method (i.e. Zoom for Healthcare). Request their contact information, and identify the best time to complete the interview.

2. Determine what medication information/sources are available

  • Drug Information System (DIS) record
    • NSHA and IWK Medication Reconciliation Report
    • NSHA and IWK Ambulatory Medication Reconciliation Report
  • Community pharmacy record
  • Patient medication list, medication vials and/or blister pack
  • Medication administration record (MAR) (i.e. from nursing home)
  • Hospital pharmacy and/or high cost drug program medication records
  • Other medication records if available (i.e. recent outpatient/admission/discharge med rec)

3. Interview patient/family/caregiver

    Outpatient medication reconciliation 

  • For an outpatient medication reconciliation (i.e. ambulatory care clinics) where the patient/caregiver agrees to communicate via a personal device:
    • Contact the patient/family/caregiver using a Nova Scotia Health approved phone or a Nova Scotia Health-approved video chat method.

    Inpatient medication reconciliation

  • For units with Nova Scotia Health phones or video chat enabled devices (i.e. iPads) inside patient rooms:
    • Call the patient’s designated phone or dial locating to request to call a patient’s room

           OR

    • Start a video chat with the patient/family/caregiver via Nova Scotia Health video chat enabled device
  • For units without Nova Scotia Health phones/devices inside patient rooms, where the patient/family/caregiver agrees to communicate via personal device:
    • Contact the patient/family/caregiver using a Nova Scotia Health approved phone or a a Nova Scotia Health-approved video chat method.
  • For inpatients on precautions (i.e. COVID positive) where no phone/device is available, work with the patient’s health care team to relay specific questions during the next direct-care interaction (bundled care approach).
  • If the patient/family/caregiver has additional sources of information to share (e.g. medication lists, medication vials, blister pack), request that the patient/family/caregiver send documents via a Nova Scotia Health-approved messaging platform (i.e. Zoom for Healthcare messenger) or email documents or photos to a designated Nova Scotia Health email address (see Electronic Messaging of Personal Health Information Policy and Procedure AD-AO-045).

4. Document the BPMH or Med Rec as per policy

  • Ensure all sections of the BPMH/Med Rec form are complete.
  • Place the completed BPMH in the patient’s chart/record for review by the health care team.
  • In some care areas consider faxing the completed BPMH/ Med Rec to the patient’s community pharmacy and/or primary health care provider, or provide a copy to the patient.
  • In outpatient settings you may also need to send the completed BPMH/Med Rec to health records for scanning. This is to ensure that the document is available to other clinicians.

Operationalization of Medication Reconciliation Policy and Procedures