The Joint Commission on Accreditation
of Healthcare Organizations
wants all hospitals to
adopt a systemic approach to the reconciliation
of medications, starting at the
time a patient is admitted to the hospital.
Medication reconciliation is the process
of comparing a patient's medication
orders with all of the medications he or
she has been taking.
Make a Complete List
The process should include making a
complete list of medications (prescription,
OTC, and herbals) the patient is taking.
The medication list should be verified,
clarified, and reconciled (documenting
every single change and making sure
of its accuracy with all other medication
information).
Reconciliation should take place
within the first 24 hours of the patient's
admission. The process also should
include checking for duplications and
omissions and identifying any highalert
medications (eg, digoxin, warfarin,
or phenytoin) and potential interactions.
Be Accurate!
The reconciliation process needs to be
as accurate as possible to prevent
numerous prescribing and administration
errors. This process should not totally
rely on the information gathered from
the patient; getting information from the
patient may actually be the most unreliable
part of the process. Many patients
are reluctant to share information. They
may not want their primary care physician
(PCP) to know that they went to
another physician to get a medication
the PCP would not prescribe.
Indeed, the reconciliation process
does not have to wait until a patient is
admitted to the hospital. It should be
initiated whenever possible in the
physician's office. Physicians should
request copies of the hospital's reconciliation
form/order sheet to keep in
their office.
Educate Patients
Patients should be educated at every
opportunity about the importance of the
medication-reconciliation process. Educational
programs should be conducted
throughout the community to explain the
importance and the purpose of the
process.
Dr. Dutcher is a clinical pharmacist
for B&B Clinical Consultants, Punta
Gorda, Fla.
