What Is Medication Reconciliation and Why Would You Need It?

What Is Medication Reconciliation?

Medication reconciliation is the process of reviewing your current medications to ensure they’re accurate, necessary and safe, especially when your prescriptions come from multiple clinicians.

Whether you're managing a chronic condition, recovering from a hospital stay or juggling pain relief and discharge medications, keeping your list organized can be overwhelming. To help manage it all, your primary care provider may recommend medication reconciliation, a process where all of your current medications are reviewed to ensure dosages are correct and to identify any potential allergies, duplications or harmful interactions.

This simple yet important step helps reduce medication errors and ensures you receive safe, coordinated care across all your providers.

Read on to learn what medication reconciliation is, why it matters and how the process works.

Medication Reconciliation in Primary Care Settings

Managing multiple medications can be hard. Some medications need to be taken on an empty stomach or at night, while others must be taken multiple times a day. Keeping things organized and scheduled is key to keeping your treatment plan on track.

Medication reconciliation can help you catalog all your current medications and make managing them a much simpler and safer process.

Why It Matters in Primary Care Offices

Knowing what medications you’re currently taking and understanding what they’re for is essential for keeping you safe and continuing your healing. Your primary care provider can make sure your medications work properly and that they’re all still needed.

The medication review workflow helps PCPs:

• Have your best possible medication history, including both prescription and over-the-counter (OTC) medications, vitamins and supplements.
• Verify that your dosages are still accurate.
• Check for duplicate medications, omissions, allergies or potential interactions.
• Prevent medication discrepancies, especially when managing chronic conditions like diabetes, hypertension and heart disease.
• Educate you about the medications you’re taking so you and your loved ones understand how they work and any potential side effects.
• Support safe prescribing when adding or adjusting medications.
• Offer a full medication list to patients, their families and other health care providers for when they need it.

When Medication Reconciliation Happens in Primary Care

There are a few times throughout your primary care history where you and your primary care doctor will participate in a medication review.

• Annual Wellness Visits: Every year you and your PCP will have a medication review to help ensure your long-term treatment plans are still appropriate.
• Chronic Disease Management Appointments: Helps prevent medication interactions and side effects if you are on multiple prescriptions.
• Post-Hospitalization or Specialist Visits: Ensures any medication changes made in other health care settings, such as hospital admission, ambulatory specialty clinics, outpatient rehabilitation centers, and inpatient long-term care facilities are correctly integrated into your primary care plan.
• Care Transition: If you're moving to a new PCP, your current PCP will make sure you have the most up-to-date list of your current medications, which will then be reviewed by your new PCP.

How Primary Care Providers Conduct Medication Reconciliation

Now that you have a better idea of what medication reconciliation is, let’s break down how your PCP performs the process.

• Step 1: Your PCP will first review your full medication history that they have on file in your health records, including both prescription and OTC medications, vitamins and supplements.
• Step 2: Your PCP will ask you if there have been any changes to your medication list and if so, what they are.
• Step 3: Once your medication list is fully updated, your PCP will review it carefully to look for any potential duplications, possible drug events from interactions or possible allergens.
• Step 4: Next, your PCP will ask you about your adherence to your medication regimen. Are you still taking all your medications? Are there any medications you’ve stopped taking?
• Step 5: You'll have the opportunity to speak with your PCP about any side effects you may have or might be experiencing.
• Step 6: From there, your PCP will compare your medical records with pharmacy data and specialist recommendations to adjust dosages and update medication information on your list as necessary.
• Step 7: Your PCP will fully explain in detail any changes made to your current medication list and why they were made.
• Step 8: Depending on how many medications you are on and the number of changes made, your PCP may schedule another medication reconciliation with you in three to six months to make sure you aren’t having any problems.

Patient Involvement in Medication Reconciliation

You as the patient play a critical role in the medication reconciliation process. Your PCP and other health care professionals are not with you every day, so they don't know all the medications you’re taking — including supplements and vitamins — and they don't know if you're experiencing any side effects or interaction effects.

For example, if you find one of your medications makes you feel a bit nauseous, that could be a side effect of the drug, or could be a sign that it's interacting badly with another medication you're taking.

To ensure your medication list is always accurate and up-to-date, it's your responsibility to:

• Bring an updated medication list to every primary care appointment.
• Inform your PCP about any medication orders made by specialists, hospital discharge or personal decisions.
• Ask your primary care doctor questions about potential interactions, side effects or alternative treatment options to be knowledgeable about medication safety.

By integrating medication reconciliation interventions into routine primary care, providers can help:

• Enhance patient safety
• Ensure patients and their caregivers understand medication dosages
• Improve health outcomes
• Make transitions from one doctor to another much easier
• Reduce the risk of medication use complications and patient harm
• Build communication between doctors and their patients

Stay Safe With an Accurate Medication List

We understand how tough it can be to balance multiple medications. While pill organizers can be a great help, they don’t ensure your dosages are correct or provide you with information about potential side effects or interactions.

A full review of all your medications at least once a year is vital to keeping you healthy by preventing medication errors, and ensuring that your medications are doing what they’re supposed to do.

If it’s time for you to meet with your PCP for a medication reconciliation, schedule an appointment today at your nearest AdventHealth Primary Care+ provider.

Frequently Asked Questions About Medication Reconciliation

What is medication reconciliation, and why is it important for patient care?

Medication reconciliation is a critical part of patient care that involves reviewing and confirming all the medications you’re taking. This helps ensure accuracy, prevent harmful interactions and avoid medication errors, especially during care transitions, such as when you're admitted to the hospital or discharged.

When does medication reconciliation typically happen?

It usually takes place at key moments in your care, such as during admission, transfer or discharge. This includes visits to the emergency department, stays in the intensive care unit or when receiving discharge orders after hospitalization. These transitions are when medication lists are most likely to change, and reconciliation helps keep your patient medication record up to date.

Who is allowed to perform medication reconciliation?

Medication reconciliation can be completed by various members of your care team, including doctors, nurses and pharmacy technicians. Each plays a role in making sure your current medications, including prescriptions, over-the-counter drugs and supplements, are reviewed for safety and accuracy.

What is admission medication reconciliation?

Admission medication reconciliation happens when you're first admitted to a hospital or care facility. It ensures that your care team knows exactly what medications you were taking at home, helping guide safe and effective treatment while you're in the facility.

What is medication reconciliation vs. medication management?

Medication reconciliation is a specific step in the process of medication management. It involves reviewing and verifying all the medications you’re taking, especially during care transitions.

Medication management, on the other hand, is an ongoing service that includes monitoring how well medications are working, adjusting dosages, managing side effects, and supporting you in following your treatment plan. Learn more about what medication management is.

Simply put, medication reconciliation is a part of medication management services, and both are essential to safe, effective patient care.

What is the difference between a medication review and medication reconciliation?

A medication review is a general assessment of your medications, often done during routine checkups to ensure your treatment is effective and appropriate. Medication reconciliation, on the other hand, is a more detailed and structured process that occurs during care transitions (like hospital admission or discharge) to ensure that medication lists are complete, accurate, and safe. Reconciliation also includes checking for duplications, interactions, and ensuring that any changes are clearly documented and communicated.

How can I help ensure my medications are reconciled correctly?

Keep an up-to-date list of all medications you take, including dosage and frequency, and share it with your care team during every visit. Let them know about any changes, allergies, or side effects. This simple step can greatly improve your patient care experience and safety.

Is medication reconciliation part of a larger quality improvement effort?

Yes. It’s supported by health systems and organizations focused on quality improvement and patient safety, such as the Agency for Healthcare Research and Quality (AHRQ), The Joint Commission, and the Institute for Healthcare Improvement (IHI). In fact, medication reconciliation is part of The Joint Commission’s National Patient Safety Goals to reduce preventable medication errors.