Complete medication reconciliation within 24 hours of admission and write a prescription that reflects medical history and medication reconciliation results.

Record any medications changed during hospital stay and the reason for the change.

Complete medication reconciliation process and IDL upon discharge.

Complete and verify medication reconciliation process within 24 hours of admission.

Ensure prescribed medication is accurately reflected in the prescription record.

Review IDL with comprehensive reference to the patient's clinical record and medication information.

Notify the physician if a discrepancy is identified in the prescription record or IDL and resolve the discrepancy.

Notify physicians of discrepancies in prescription records, resolve with physicians and pharmacists any discrepancies found prior to IDL final verification and approval at discharge.

Prescribe temporary medications based on medication history.

Determine whether to continue, stop, or change medications during the hospital stay.

Reconcile pre-admission medications with current medications upon discharge.

Enter prescribed medications upon discharge into the EMR.

Review the pre-admission medication history completed by the pharmacy assistant.

Review the pre-admission medication history and physician’s prescription list.

At discharge, comprehensively review the pre-admission medication history, patient’s current medication list, and discharge prescription.

Communicate any changes to the discharge prescription list with the patient/caregiver and provide counselling education.

Collect the patient’s medication history upon admission.

Enter the patient’s inpatient medication prescription into the EMR after admission.

Identify any changes to the patient's pre-admission medication history and add them to the preadmission medication list.

Communicate the discharge plan to the patient upon discharge and perform medication adherence guidance.

Provide a medication history prior to admission.

Co-operate with a doctor or nurse checking your medication history after admission.

Identify medications the patient took prior to admission

Review BPMH in the ‘Medications on Admission’ tab and ‘Activate Plan’ in MedChart, taking into account pharmacist recommendations.

Interview the admitted patient or caregiver about medication history and create a medication management plan.

Document the inpatient’s regular medication management plan in MedChart or MRF.

Review the medications prescribed based on the patient’s clinical condition, treatment goals, and treatment plan.

Manage patient’s PODs, check patient’s medication history.

Pre-admission clinic nurse records patient’s BPMH for pre-operative medication plan.