Medication reconciliation is the process of comparing a patient's medication orders with a list of all the medications the patient has been taking. Reconciliation helps avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. The Joint Commission recommends it be done at every transition of care that involves ordering new medications or the rewriting existing orders.
Transitions in care include changes in setting, service, practitioner, or level of care. Reconciliation involves five steps:
- Develop a list of current medications.
- Develop a list of medications to be prescribed.
- Compare the medications on the two lists.
- Make clinical decisions based on the comparison.
- Communicate the new list to appropriate caregivers and the patient.
Errors resulting from failure to reconcile medications may be compounded by the practice of writing "blanket" orders, such as "resume pre-op medications," which are highly error prone and are known to result in adverse drug events.
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