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Medication errors commonly occur as the patient moves through the continuum of care. According to the Joint Commission, 63% of reported medication errors were due to a breakdown in communication which could have been avoided by completing a medication reconciliation.1 In 2004, the Joint Commission included medication reconciliation across the continuum of care to the 2005 National Patient Safety Goal #8. Thus, medication reconciliation can and should occur at each care transition. This includes when the patient is moving from one healthcare setting to another, transferring from one level of care to another (e.g., intensive care unit to medical unit), and seeing different care providers.

Medication reconciliation is defined as the process of creating the best possible medication list of all the medications the patient should be taking, which is accomplished by comparing the patient’s active medication orders or prescriptions to all of the medications that the patient has been taking.1,2 The goal of medication reconciliation is to avoid medication errors that may lead to an unwanted adverse drug event. Medication errors commonly occur when there are medication discrepancies in the patient’s medication list(s). These errors may consist of omissions, commissions, dosing errors, duplications, or drug interactions.1,3

There are many strategies to facilitate a successful medication reconciliation. These strategies include but are not limited to focusing on high-risk patient groups, especially if limited resources are an issue.3 These high-risk patient groups include but are not limited to those with evidence of polypharmacy, use of high-risk medications (anticoagulants, insulin, etc.), limited health literacy, elderly, complex medical or behavioral conditions, and medical conditions or procedures that fall under the Centers for Medicare & Medicaid Services Hospital Readmissions Reduction Program (acute myocardial infarction, chronic obstructive pulmonary disease, heart failure, pneumonia, coronary artery bypass graft surgery, and elective primary total hip arthroplasty and/or total knee arthroplasty). Additionally, when implementing medication reconciliation, one should consider utilizing all pharmacy personnel to perform various aspects of the medication reconciliation process. Pharmacy technicians and student pharmacists may collect a medication history and pharmacy residents and licensed pharmacists can complete the medication reconciliation process. Furthermore, it is important to obtain buy-in from leadership and frontline staff to help champion the medication reconciliation program. Lastly, engage the patient and empower them to take charge in ensuring they are receiving and taking the best possible medication list.

Completing medication reconciliation is not without its challenges. Medication reconciliation may be difficult to implement due to patient, provider, and healthcare setting barriers.3 Patients may have low health literacy and have limited knowledge of their medications. Providers may have limited time to complete the medication reconciliation or have limited knowledge of what medication(s) the patient is taking if it was prescribed by a different provider. Furthermore, healthcare setting factors ...

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