medication reconciliation

Introduction

Identifies indication for each medication.

Indications

Goals:

• insure patients are on right medications after going in or out of hospital, nursing home ...

Legal:

• required each time a patient transfers into or within or out of a healthcare facility (JCAHO)

Clinical significance

• can reduce medication errors by 70%

Management

• ask patient to bring in all medications, including
  • prescription medications
  • over-the-counter medications
  • supplements & herbal preparations
• for prescription medications, determine whether the directions of the label match those in the patient's chart
  • ask patient how he/she is taking the medication
• ask about medication adverse events
• ask about other medications prescribed by other providers
  • evaluate indications for each
• eliminate medications with duplicate therapeutic or pharmacologic properties
• screen for drug-drug interactions & drug-disease interactions
• eliminate unnecessary medications
  • consult with other providers as needed
• simplify medication regimen
  • use fewest number of medications & doses/day
• always preview any change with patient & caregiver
  • provide changes in writing

Notes

• not always done correctly
• medication reconciliation by hospital pharmacists or pharmacy technicians similarly effective (& better than usual care) in cutting medication errors

More general terms

• medication management

Additional terms

• medication compliance (taking medicine)