langcare-medication-reconciliation

Medication Reconciliation

When to Use This Skill

Use when a clinician needs to reconcile medications across care settings per Joint Commission NPSG.03.06.01 -- admission, discharge, or transfer.

Clinical Workflow

1. Use fhir_search to pull active MedicationRequest resources (prescribed orders) with status=active,on-hold
2. Use fhir_search to pull active MedicationStatement resources (patient-reported home medications)
3. Use fhir_search to pull MedicationAdministration resources (inpatient administered medications) filtered by admission date
4. Use fhir_search to pull active AllergyIntolerance and Condition resources for safety cross-reference
5. Normalize all medications to RxNorm codes; build unified comparison table with columns: Medication, Dose, Frequency, Route, Source, Status
6. Identify discrepancies: duplicates, therapeutic duplications (same drug class), dose changes across sources, discontinued meds still listed active, medications with no matching indication, allergy conflicts
7. Flag ISMP high-alert medications (anticoagulants, insulin, opioids, chemotherapy) for extra scrutiny
8. Present reconciliation report and use fhir_update to update MedicationStatement/MedicationRequest status if authorized

FHIR Resources

• MedicationRequest -- Prescribed orders: status, intent, medicationCodeableConcept, dosageInstruction, authoredOn
• MedicationStatement -- Patient-reported medications: status, medicationCodeableConcept, dosage, informationSource
• MedicationAdministration -- Inpatient administrations: status, medicationCodeableConcept, dosage, effectiveDateTime
• AllergyIntolerance -- Drug allergy cross-check
• Condition -- Validate medication indications

FHIR Query Examples

Pull Active Prescriptions

fhir_search(resourceType="MedicationRequest", queryParams="patient=[patient-id]&status=active,on-hold&_include=MedicationRequest:medication&_count=100")

Pull Patient-Reported Medications

fhir_search(resourceType="MedicationStatement", queryParams="patient=[patient-id]&status=active,intended,on-hold&_count=100")