medication reconciliation

what is medication reconciliation?

making one clean, correct list of every med a patient takes, then comparing it to the new hospital orders and fixing any mismatches so nothing is missed, doubled, or unsafe

when does medication reconciliation happen?

after the transfer of a patient anywhere

• surgery, floor transfer, discharge

what should we make sure there is none of when doing a medication reconciliation?

no duplicates, omissions, or any meds unsafe to take together

if we find something wrong during medication reconciliation, what do we do?

notify the provider

goal of medical reconciliation

keeping medications current

what is done to home medications once a patient is admitted to a hospital ?

they are discontinued on admission

how do we know what home medications should be taken after a patient is admitted?

the provider picks what medications to keep

what do we do if a patient brings their home medications to the hospital?

store them safely

benefits of medication reconciliation

• ensures healthcare team agreement

• helps with deperscribing

• prevents duplications, omissions, or interactions

• assess financial burden w social worker

• increases communication

what does medication reconciliation ensure?

healthcare team agreement

what does medication reconciliation help with?

deperscribing

• ex: patient has been on the same antibiotic for 6 months