Comprehensive Medication Management

Sites within the University of Minnesota Postgraduate (PGY1) Pharmacy Residency Program will provide comprehensive medication management services to patients. This includes participation in the full patient care process of assessment, care plan development, follow-up evaluation, and appropriate documentation of this care. Each site within the residency program will be asked to demonstrate that they are meeting these standards.

Definitions

Comprehensive Medication Management 

Comprehensive medication management is defined as the standard of care that ensures each patient’s medications (whether they are prescription, non-prescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the patient, effective for the medical condition, safe given the comorbidities and other medications being taken, and able to be taken by the patient as intended.1 The pharmacist takes responsibility for the patient’s drug related needs and is held accountable to this commitment.

Provision of comprehensive medication management requires a standardized patient care process which consists of:

  • An assessment of patient’s drug-related needs
  • Identification of the patient’s medication-related problems
    • Appropriateness of the medication
    • Effectiveness of the medication
    • Safety of the medication
    • Adherence to the medication
  • Development of a care plan with individualized therapy goals and personalized interventions
  • Follow-up evaluation to record patient outcomes, evaluate progress in meeting goals of therapy, and to reassess for new problems.2

Documentation of Comprehensive Medication Management1 

  • A record of the patient’s medication experience (understanding, concerns, preferences, beliefs, behavior)
  • Medication allergies and adverse reactions
  • Medication history (including immunizations) 
  • Assessment of current medical conditions
  • Current medication record (including all medications regardless of source, mode of administration, or prescriber), indication for use, product, dose, duration, and how the medication is actually being taken
  • Active drug therapy problem list, complete with the cause of each problem (associated with the medical condition and medications relating to the drug therapy problem)
  • Therapeutic treatment plan and follow-up for the patient and practitioner. 
  • Communication of care plan with the patient’s health care team

References

  1. McInnis TM, Strand LM, Webb CE. The Patient-Centered Medical Home: Integrating Comprehensive Medication Management to Optimize Patient Outcomes Resource Guide. 2nd edition. June 2012. Patient-Centered Primary Care Collaborative. 
  2. Cipolle RJ, Strand LM , Morley PC. Pharmaceutical Care Practice: The Clinician's Guide. McGraw-Hill, 2004.