MANAGEMENT OF

MEDICATIONS
 Medication
Reconciliation
 What is Medication Reconciliation?

• Medication reconciliation is ‘the process of obtaining, verifying and

documenting an accurate list of a patient’s current medications on admission
and comparing this list to the admission, transfer, and/or discharge medication
orders to identify and resolve discrepancies.’

• It is a formal process for creating the most complete and accurate list
possible of a patient’s current medications and comparing the list to those in
the patient record or medication orders.
 Why to do Medication Reconciliation?

 To ensure that all the patients receive appropriate medication reconciliation

on admission, transfer and discharge.

 To ensure that all appropriate regular medication is prescribed.

 To avoid medication errors such as omissions, duplications, dosing errors,

or drug interactions.
 Medication Reconciliation...
When and How?

‘At every transition of care in which new medications are ordered or existing
orders are rewritten.’

 At the time of Admission :

• List of current medications should be obtained, verified & documented.
• It should be as complete as possible to include dose, strength, and frequency.
(Best Possible Medication History)
• When the patient is not able to provide the information, assistance should be
sought from family or accompanying person.
• Medication administration record should be created by comparing the current
medication and the medications to be prescribed.
• The new list then should be communicated to appropriate caregivers.
 At the time of transfer to different level of care :
• The patient’s provider should reconcile the medications & should give a
copy to patient.
• This should be shared with the next provider of care.
• The communication shall be documented in the record.
• In case of emergency/urgent transfer due to patient’s condition, the
reconciliation may be completed by the receiving provider as soon as it is
possible.
 At the time of discharge :
• The post discharge medication regimen should be determined.
• Discharge instructions for the patient for home medications should be
developed & the patient should be educated.

 For patients in ambulatory settings :

• The complete medication list that was obtained on prior visit will be
reviewed at each recurring visit with the patient to ensure that there have
been no changes to the medication regime.
• Any changes to the medication list shall be documented in the record.
THANK YOU