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#1
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Nurses are filling out the MedRec on admissions
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Patient’s own document sheet (PODS) not given to all patients
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Patients do not receive a complete list of medications from community pharmacy
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Lack of communication between hospital physician and community pharmacist
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#2
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BPMH are collected through single source instead of 2–3 sources to verify the information
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PODS not given to community pharmacies
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The discharge summary report has discrepancies
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Discharge report is missing information like limited use codes
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#3
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MedRec on transition of care is missed most of the time
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No information provided for where community pharmacies can contact to clarify discrepancies—most staff unwilling to help once patient is discharged
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Patients/caregivers are not interviewed often when obtaining a BPMH
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There are often discrepancies between medications prescribed by hospital physician and family physician
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#4
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MedRec on discharge do not include patient counseling points. Also, patient medication changes are not always given to patients upon discharge
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PODS not reviewed with patients
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BPMH is not commonly done proactively
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Lack of laboratory results hinders ability to monitor patients on new, changed medications
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#5
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Communicating the changes are not always shared with community pharmacist, long-term care facilities and family doctors
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Discharge prescriptions and PODS/summary of visit are not sent to the patient’s community pharmacy upon discharge
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MedRec often not completed accurately. Patient medication list is often missing over-the-counter medications
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