Your Name and Title *

Facility Name *

Current electronic health record (check all that apply) *

How satisfied are you with your current medication reconciliation process? *

Do you feel your hospital staff has adequate training in medication reconciliation to properly perform the practice?

Do you feel your hospital has adequate staffing resources to properly perform medication reconciliation processes?

Where are medication reconciliation processes conducted in your facility? (i.e. which outpatient units and/or clinics)

When is medication reconciliation conducted at your facility? (check all that apply)

Who obtains the patient's medication history?

What tools are being utilized to obtain a current medication history? *

How accurate do you believe the patient's medication history is being taken? *

Is the discharge medication reconciliation maintained in your EHR?

On average, how much nursing time per patient is allocated to the ADMISSION medication reconciliation processes from the Emergency Department? *

On average, how much nursing time per patient is allocated to the DISCHARGE medication reconciliation processes? *

On average, how much physician time per patient is allocated to the ADMISSION medication reconciliation processes from the Emergency Department? *

On average, how much physician time per patient is allocated to the DISCHARGE medication reconciliation processes? *

On average, how much pharmacist time per patient is allocated to the ADMISSION medication reconciliation processes from the Emergency Department? *

On average, how much pharmacist time per patient is allocated to the DISCHARGE medication reconciliation processes? *

On average, how much technician time per patient is allocated to the ADMISSION medication reconciliation processes from the Emergency Department? *

On average, how much technician time per patient is allocated to the DISCHARGE medication reconciliation processes? *

What do you believe is the true cost of conducting medication reconciliation at your facility on an annual basis? *

Is the estimated (or documented) frequency of significant medication errors associated with medication histories/medication reconciliation LESS than 5% at your facility? *

From NURSING perspective, did your facility's EHR improve the medication reconciliation process?

From PHYSICIAN perspective, did your facility's EHR improve the medication reconciliation process?

From PHARMACY perspective, did your facility's EHR improve the medication reconciliation process?

Do you believe an accurate medication reconciliation process reduces length of stay and/or prevents hospital readmissions? *

Do you believe medication reconciliation is important for continuity of care? *

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