Medication Reconciliation: Useful Tool or Box to Check?

Tom G. Bartol, NP


August 30, 2018

A clinic visit, hospital admission, or transition in care often begins with medication reconciliation. Developed to provide safer, more coordinated, and better-quality care, medication reconciliation has become a somewhat automatic process, lacking critical appraisal or evaluation of the medications in the context of the patient's current clinical status.

Medication reconciliation is performed to avoid such medication errors as omissions, duplications, dosing errors, or drug interactions. Despite all of the emphasis on this process and its importance, little, if any, data have shown that medication reconciliation, as it is practiced now, has improved healthcare.

In theory, medication reconciliation—the process of "identifying the most accurate list of all medications that the patient is taking, including name, dosage, frequency, and route, by comparing the medical record to an external list of medications obtained from a patient, hospital, or other provider," as defined by the Centers for Medicare & Medicaid Services—makes a lot of sense.[1] The end product, however, is rarely scrutinized or even shared. The outcome most often measured is whether the medication reconciliation box has been checked off.

Patients would benefit far more, and quality of care and safety would improve, if each medication was actually reviewed. This would involve assessing the appropriateness of each prescribed drug, on the basis of clinical status and patient report. Questions that must be asked include whether the medication is still indicated. Can the patient afford it? Does the patient take the medication as prescribed or recommended? Does the patient want to continue taking it?

An accurate and complete list of medications that the patient is taking can be a helpful tool, but in creating the list, the goal must not be simply to check a box in the patient's record. Rather than just carrying the entire medication list forward at each encounter, the reconciliation process permits clinicians to assess whether the medication is having the desired effect and the patient's condition has improved when taking the medication. It's an opportunity to deprescribe or discontinue medications that are deemed unnecessary, inappropriate, or not desired any longer by the patient.[2]


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