Pharmacy Times

Medication Reconciliation Is Key

Author: Robert Dutcher, PharmD

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.