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Medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient’s current medications and comparing the list to those in the patient record or medication orders since the health change status of the patient. The steps in medication reconciliation are seemingly straightforward. For a newly hospitalized patient, the steps include obtaining and verifying the patient’s medication history, documenting the patient’s medication history, writing orders for the hospital medication regimen, and creating a medication administration record. At discharge, the steps include determining the post-discharge medication regimen, developing discharge instructions for the patient for home medications, educating the patient, and transmitting the medication list to the follow-up physician. For patients in ambulatory settings, the main steps include documenting a complete list of the current medications and then updating the list whenever medications are added or changed.

A comprehensive list of medications should include all prescription medications, herbals, vitamins, nutritional supplements, over-the-counter drugs, vaccines, diagnostic and contrast agents, radioactive medications, parenteral nutrition, blood derivatives, and intravenous solutions (hereafter referred to collectively as medications). Over-the-counter drugs and dietary supplements are not currently considered by many clinicians to be medications, and thus are often not included in the medication record. As interactions can occur between prescribed medication, over-the-counter medications, or dietary supplements, all medications and supplements should be part of a patient’s medication history and included in the reconciliation process.

Gathering, Organizing and Communicating

However, the process across the continuum of care is not straightforward. First, there is tremendous variation in the process for gathering a patient’s medication history. Second, there are at least three disciplines involved in the process – medicine, pharmacy, and nursing -with little agreement on each profession’s role and responsibility for the reconciliation process. Third, there is often duplication of data gathering with both nurses and physicians taking medication histories, documenting them in different places in the chart, and rarely comparing and resolving any discrepancies between the two records.

Additionally, patient acuity may influence the process of reconciliation. For example, a patient admitted for trauma may result in cursory data gathering about the medication history. Alternatively, a patient with numerous comorbidities may stimulate gathering a complete list of current medications. In general, there is no standardization of the process of medication reconciliation, which results in tremendous variation in the historical information gathered, sources of information used, comprehensiveness of medication orders, and how information is communicated to various providers across the continuum of care.

To experience our Medication Reconciliation Program and work collaboratively to reduce Medication errors contact us today to get started.

Our @HomeCore Solutions™ Medication Reconciliation Program is designed on the foundation of the Joint Commission guidelines in medication compliance and by incorporating these principles mitigation of the 30day readmission reduction can be achieved by empowering the patients on the Proper Use and Knowledge of Medications importance to adherence.

According to The Joint Commission

This process comprises five steps:
1. Develop a list of current medications including over the counter medication
2. Develop a list of medications newly prescribed
3. Compare the medications on the two lists
4. Make clinical decisions based on the comparison
5. Communicate the new list to appropriate healthcare team and to the patient and their family members

@HomeCore Solutions™ Medication Reconciliation Program Benefits: 

1. Starts with admission and ongoing education thereafter in the comfort of the patients home

2. Monitors medication compliance with pill box utilization, non-compliance  is addressed with further education

3. Transfer script to auto refills

4. Available to all patients regardless of diagnosis