Basics of Medication Reconciliation

Consider these tips for effectively performing medication reconciliation

An older adult holds four pill bottles

Medication reconciliation is a critical process for avoiding omissions, duplications, dosing errors, and interactions. Sterling Ransone, MD, president-elect of the American Academy of Family Physicians, and Frank Federico, RPh, vice president of the Institute for Healthcare Improvement, offer tips for facilitating this key aspect of patient safety.

Start with the basics. Medication reconciliation involves:

  • Comparing medications that the patient is currently taking with those that have been prescribed
  • Making clinical decisions based on the comparison
  • Communicating any changes to the patient

The simplest way to begin is to have patients make a list of their medications. “All patients should carry a medication list in their pocket or purse or on their person,” Federico suggests. Smartphone apps are also now available for this purpose, he adds.

The second step is interviewing the patient to find out whether he or she is taking the medications in the correct dosage. “It is important to ask, ‘How are you taking your medications?’, not, ‘Are you taking your medications?’” Federico points out.

In Ransone’s practice, front-office staff ask patients to review a list of current medications from their EHR before the appointment. Clinical staff then review the list with them.

“We also like our patients to bring in their pill bottles, [including] supplements,” Ransone says. “Usually, between the patient, nurse, and myself, [the list] has been reviewed three times.”

Ask about ophthalmic and topical preparations. Patients often do not report the use of ophthalmic and topical formulations—medications that can cause major adverse effects if combined with other drugs.

Be aware of critical stages for medication reconciliation. Medication reconciliation should be performed at each office visit, according to Ransone. But providers should be familiar with the most critical times for performing medication reconciliation, such as when the patient has recently experienced one of the following:

  • Being in the ED or hospital
  • Seeing a specialist
  • Being admitted and discharged from a nursing home

Other critical times include new-patient visits and when a patient is seen infrequently, Federico adds.

Two-way communication with specialists and hospitalists is key to ensuring medication safety, Ransone emphasizes. It is crucial that medication lists always travel with the patient and that the provider has a protocol for communicating with other medical systems.

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