Admission medication reconciliation reliably captures the name and the dose of a basal insulin. It much less reliably captures the three things that determine what happens next: when the patient actually injects it, whether they have been skipping doses, and what their own correction habit looks like.
A patient whose chart says 24 units at bedtime may have been taking 18 for three months because of nocturnal hypoglycaemia, or taking it at 9 pm rather than 11 pm, or adding four units whenever a reading exceeds 250 mg/dL. Prescribing the charted regimen unchanged reproduces none of that, and the first inpatient hypoglycaemic event is often the result.
Ask three questions at admission: what time do you actually take it, when did you last miss a dose, and what do you do when your sugar is high. It takes under a minute and it is the difference between a reconciled list and a usable one.
- Ask the injection time, not just the dose - bedtime means different hours to different patients.
- Ask directly about missed doses; underuse because of hypoglycaemia is common and rarely volunteered.
- Ask what the patient does for a high reading, and write that habit into the plan.
- Record who administers the injection at home, since a family member may be the one who knows.
- Re-check the regimen against the home routine before discharge, not on the day of discharge.
Why it matters
Most inpatient hypoglycaemia traces back to a home regimen that was copied accurately and understood not at all.
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