1. Medication Reconciliation Steps
Continuity of Care Patients 65 years and older have multiple medical problems, are on multiple medications, and are seen by multiple providers. Having a primary care physician, communicating among all providers, and reconciling medications are all essential for quality patient care.
Medication Reconciliation Steps
Ask the patient…
1. What are the names of the medications (including OTC, vitamins and herbal supplements) you are currently taking?
2. How do you take your medications and how much have you been taking?
3. Do you understand what the medication is for?
4. Where do you get your prescriptions filled?
MD action…
1. Compare home list to the list in the patient’s chart.
2. Ensure dose and frequency are the same.
3. If patient doesn’t understand what meds are for, educate using plain, non-medical language; speak slowly; break down information into short statement.
4. Call the pharmacy if there is any discrepancy between the patients’ reported meds and your list. Rectify in the patient’s chart.
Obtain medication
list from patient
Obtain medical record
medication and
problem list
Identify discrepancies
Call pharmacy or call family
Enumerate all meds
Reconcile list
Consolidate meds
Evaluate ongoing need of each med.
Optimize the list
Incorporate into med list
Document updated
medication list
Give patient a copy of updated medication list
Include updated list in clinic note
Funding provided by D.W. Reynolds Foundation
References: Wenger, N.S. and R.T. Young (2007) “Quality Indicators for Continuity and Coordination of Care in Vulnerable Elders.” JAGS 55:S
Varkey, P. et al (2007) “Improving Medication Reconciliation in the Outpatient Setting.” Jt. Comm J on Quality & Patient Safety 33:5.