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Reconciling medications across the continuum of care is a tough assignment. Find out how a group of experts made medication reconciliation easy.

Accreditation Connection, May 23, 2005

The Reconciling Medications Collaborative, sponsored by the Massachusetts Coalition for the Prevention of Medical Errors and the Massachusetts Hospital Association, identified some of the most effective ways to reconcile medications.

The group includes representatives from hospitals across the state, including physicians, nurses, pharmacists, and case managers. After trying different approaches in their own hospitals for two years, the Massachusetts collaborative developed the following best practices for reconciling medications:

1. Assign reconciling duties to someone who has sufficient expertise

The group found that floor, triaging, or admission nurses tended to be the best candidates for reconciling medications, although some hospitals found that the pharmacist was their best choice. Other hospitals felt that it was necessary to require pharmacist involvement only for high-risk patients (e.g., patients who take high-risk medications or elderly patients who take more than five different types of drugs).

Tip: Create a standardized medication reconciliation form and place it in a visible location in the patient's chart. Consider turning the form into a medication order sheet. The form should include the following:

 the dosage and frequency of each medication
 the date and time of the last dose
 information about the patient's compliance with prescribed dosages and frequency
 information about allergies
 a space for the verifier's initials
 a signature line for the physician

2. Reconcile patient medications within specified time frames

Establish time frames based on each patient's time of admission and medication risk. Some hospitals require the reconciliation to take place before the patient's next therapeutically prescribed dose. Others require it before morning rounds. When managing high-risk patients or high-risk medications, many hospitals require reconciliation within four hours of admission.

Tip: Develop a fail-safe backup plan to ensure that staff can reach a pharmacist 24/7, such as via a pharmacist hotline or a satellite pharmacy.

3. Develop clear policies and procedures for the steps in your reconciling process

The group agreed that the policies should address how to:

 obtain each patient's home medication list and compare it to physician orders
 contact the physician to review discrepancies and what to do if the ordering physician is not available
 pass off nonreconciled medication lists during nursing shift changes to ensure follow-up by the incoming shift
 identify high-risk situations that require involvement from a pharmacist, case manager, or special consultant
 prohibit blanket orders, such as "continue home meds" or "resume all meds"

Tip: Contact patients one or two days after discharge to make sure they filled their prescriptions.

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