Care Transitions Series: Medication Reconciliation

Part III:  Understanding Medication Reconciliation in Care Transitions

Patients with chronic conditions are often on multiple medications, which change frequently.

Medication management for these patients can be quite challenging. A key component of care transitions interventions is that of medication management and reconciliation.

According to the Institute of Medicine’s Preventing Medication Errors report, the average hospitalized patient is subject to at least one medication error per day.   More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients.  Of these errors, about 20 percent are believed to result in harm.   Many of these errors could be avoided if medication reconciliation processes were in place.

The Joint Commission defines Medication Reconciliation as the process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten.

A comprehensive list of medications should include:

  • all prescription medications
  • herbals, vitamins, nutritional supplements
  • over-the-counter drugs
  • vaccines
  • diagnostic and contrast agents and radioactive medications
  • parenteral nutrition
  • blood derivatives

Upon discharge from the hospital, The Care Transitions Coach reviews post discharge medication regimen and discharge instructions with the patient for medications that will be taken at home and assures this medication list and instructions are communicated to the follow-up physician.

After proper medication reconciliation, it is imperative that patients and caregivers are educated in accurate medication management.  We will discuss this in our next blog in this series on Care Transitions Interventions.

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