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Improving Patient Care Through Better Medication Reconciliation

Transitions in care - when a patient transfers between patient care settings or levels of care - are key points where medication reconciliation can help avoid medication-related problems. According to The Joint Commission, approximately half of all hospital-related medication errors and 20 percent of all adverse drug events have been attributed to poor communication at the transitions of care.

Pharmacists using a standardized approach, like the MTM Core Elements service model, can consistently and effectively provide medication reconciliation during care transitions. Beginning with a comprehensive medication therapy review and subsequently formulating a personal medication record, pharmacists can work with other members of the health care team to evaluate medication therapy, resolve identified problems and refer the patient to an appropriate health care professional, if needed. Effective communications among health care team members, including pharmacists in both the inpatient and outpatient settings, are an essential component of medication reconciliation processes. Proper documentation, including maximizing the use of health information technology (HIT) solutions to share important clinical information, will help avoid dangerous medication-related problems and allow the pharmacist to safely transition the patient to another health care setting or level of care.

Pharmacists’ involvement in medication reconciliation during transitions of care improves patient outcomes and reduces overall health care costs, according to numerous studies cited in the white paper. The paper advocates that pharmacists should take a leadership role in collaborating with other health care professionals in the coordination and implementation of medication reconciliation and identifies eight foundational concepts for medication reconciliation that can be applied in collaboration with other health care professionals across the health care continuum. The concepts state that medication reconciliation:

  • Is a key process to improve patient care;
  • Is a patient-centered process focusing on patient safety;
  • Requires an interdisciplinary, collaborative approach;
  • Must be based on a culture of accountability;
  • Should be standardized;
  • Requires coordinated communication;
  • Requires use of HIT solutions; and
  • Requires continuous quality improvement.
APhA and ASHP developed the white paper to stimulate discussion among health care providers and researchers on how to best research and implement improvements in the medication reconciliation process, with the goal of improving patient safety and patient care outcomes. The report can be found online at

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