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Examples of Medication Reconciliation A patient receiving for hypertension was admitted for surgery. The admitting resident did not order on admission due to concerns about perioperative hypotension.
The medication reconciliation process is the shared responsibility of healthcare providers in collaboration with patients/clients and families. It requires an inter-professional team approach that includes pharmacists, physicians, nurses and other healthcare providers.
Effective care coordination efforts, CMS goes on to state, must include medication reconciliation post-discharge.
1 The goals of medication reconciliation are to obtain and maintain accurate and complete medication in- formation for a patient and use the information within and across the continuum of care to ensure safe and effective medication use.
The medical assistant's position is that medical assistants are permitted to remove a medication from a patient's list of medications based on the patient's statement only to inform the provider that, for example, another provider has discontinued a medication.
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Advantage MD. Requires documentation of medication reconciliation documented on the date of the discharge through 30 days after the discharge (31 days total).
It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care.
Medicines reconciliation is a way to identify and act on discrepancies in patients' medical histories and it is found to play a key role in patient safety. This review focuses on discrepancies and medical errors that occurred at point of discharge from hospital.
This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.
GPs should undertake medicines reconciliation within 1 week, and should not issue new prescriptions or supplies of medicines before medicines reconciliation is complete. General practices may also liaise with community pharmacies about any medicines discharge information the pharmacies receive.

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