Medication Reconciliation Is Key

The Joint Commission on Accreditationof Healthcare Organizationswants all hospitals toadopt a systemic approach to the reconciliationof medications, starting at thetime a patient is admitted to the hospital.Medication reconciliation is the processof comparing a patient's medicationorders with all of the medications he orshe has been taking.

Make a Complete List

The process should include making acomplete list of medications (prescription,OTC, and herbals) the patient is taking.The medication list should be verified,clarified, and reconciled (documentingevery single change and making sureof its accuracy with all other medicationinformation).

Reconciliation should take placewithin the first 24 hours of the patient'sadmission. The process also shouldinclude checking for duplications andomissions and identifying any highalertmedications (eg, digoxin, warfarin,or phenytoin) and potential interactions.

Be Accurate!

The reconciliation process needs to beas accurate as possible to preventnumerous prescribing and administrationerrors. This process should not totallyrely on the information gathered fromthe patient; getting information from thepatient may actually be the most unreliablepart of the process. Many patientsare reluctant to share information. Theymay not want their primary care physician(PCP) to know that they went toanother physician to get a medicationthe PCP would not prescribe.

Indeed, the reconciliation processdoes not have to wait until a patient isadmitted to the hospital. It should beinitiated whenever possible in thephysician's office. Physicians shouldrequest copies of the hospital's reconciliationform/order sheet to keep intheir office.

Educate Patients

Patients should be educated at everyopportunity about the importance of themedication-reconciliation process. Educationalprograms should be conductedthroughout the community to explain theimportance and the purpose of theprocess.

Dr. Dutcher is a clinical pharmacistfor B&B Clinical Consultants, PuntaGorda, Fla.