Spring is a time of new beginnings and fresh starts. There is no better time to help patients review their medications and overall health than when they “awake from winter hibernation” and emerge from flu season. Medication reconciliation helps ensure that patients’ medications are accurate and safe. Through medication reconciliation, pharmacists can prevent errors associated with prescription and OTC drugs, as well as herbal and dietary supplements. The process allows for checking of omissions, duplications, dosing errors, adherence, and drug interactions. The services provided by the pharmacy team enhance communication between the provider and the patient.

The Case
KA is a 38-year-old woman and regular patient at your pharmacy. KA relies on your pharmacy as her health care hub because it is close to home and has an in-house urgent care clinic with a fulltime nurse practitioner. This makes the pharmacy a convenient first stop for her and her family’s needs. With your help at a previous brown bag session a few months ago, you suggested to KA that she consult with her primary care provider (PCP) about some possibly concerning symptoms. KA was feeling sad, anxious, and overwhelmed. Her PCP ultimately gave KA a diagnosis of mild depression. Because of that interaction, you now have an established and trusting pharmacist–patient relationship with KA.

More recently, KA has been facing personal and professional highs and lows. During a counseling session, KA gives you a list of medications and current laboratory data from a recent visit with her PCP. KA explains that her recent appointments at the hospital left her confused and frustrated. She complains, “No one listens to me. I have all these papers, and I have no idea what I’m actually supposed to do. Instead, I just get more and more medications.” You can see that KA appears tired and anxious. She is also battling spring allergies and is “feeling just miserable.”

You look through her papers and notice a record of a medication reconciliation performed by another pharmacist. When you compare it with KA’s profile at your pharmacy, you notice some discrepancies and changes. As you conduct your review, you see the concern in KA’s face. You reassure her and tell her you are helping. KA is relieved and tells you she will bring in all of her medications the next day so you can conduct another brown bag session. KA appreciated her last session and is grateful for your time and help. You suggest to KA that she come back around 3:00 pm, which is a slower time at your pharmacy and will allow you to provide her with the best service and care. Before she leaves, you take her to the aisle with the OTC allergy medications and recommend products for short- and long-term relief.

The next day, KA arrives at the appointed time. You have carefully reviewed her profile, lab data, and medication reconciliation report. You compare KA’s following brown bag contents with your information:
  • OTC omeprazole 20 mg daily
  • Ondansetron 4 mg, as needed
  • Lorazepam 1 to 2 mg, as needed
  • Sertraline 50 mg twice daily
  • Citalopram 40 mg daily
  • OTC diphenhydramine 50 mg, as needed
  • Ortho Tri-Cyclen Lo daily
  • OTC loratadine 10 mg daily
The following is KA’s pharmacy profile based on her medication reconciliation report:
  • Atenolol 25 mg daily
  • Escitalopram 10 mg daily
  • OTC multivitamin daily
  • Duloxetine 60 mg daily
One goal of a brown bag session is to discover discrepancies in treatment. Awareness can allow you to make several short- and long-term suggestions. Your advice may improve communication between KA and her PCPs, as well. This may better KA’s quality of life and reduce her risk for hospital admissions. KA is willing to have you act as a liaison between her and her PCPs, and the first step is to follow up with them. The next step is to make KA’s PCPs aware of your discoveries and your suggestions for KA’s goals and plan of care. Making time for these steps may be challenging, but it can result in patient loyalty and satisfaction. KA’s long-term health goals can be optimized by brown bag sessions and effective communication between you and KA and you and her PCPs. KA definitely needs more counseling and followup care in the community pharmacy. Considering your time restrictions, how can you help ensure that KA stays on the recommended track toward better health?


Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy degree from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, an innovative amalgam of pharmacy and cooking, appears on PharmacyTimes.com/blogs/compounding-inthe- kitchen. Read, and enjoy!