Medication reconciliation should be system-wide and occur whenever a patient transition occurs between areas or care providers, according to a JCAHO Sentinel Event warning.
“This means medication reconciliation applies to all care settings—including ambulatory, emergency and urgent care, long term care, and home care—as well as inpatient services, according to the alert.”
The alert encourages hospitals to do the following:
Create a list of current medications for the patient including over-the-counter drugs, vitamins, herbals and netraceuticals
Create a list of medications to be prescribed for the patient
Compare medications on the two lists
Make clinical decisions based on the two lists
Communicate the new list to the correct caregivers and the patient
Put the list of medications in a highly visible place in the patient's chart and include essential information about dosages, drug schedules, immunizations, and drug allergies.
Reconcile medications at each interface of care, specifically during admission, transfer, and discharge. The patient and responsible physicians, nurses, and pharmacists should be involved in this process.
Provide patients with a complete medication list that they will take after leaving the hospital, as well as instructions on how and how long to take any new medications. Staff should encourage patients to carry this list and share it with any caregivers who provide follow-up care.