What is Medication Reconciliation all about?

If you haven’t heard this phrase yet, you most likely will. This is an area that has a big focus on energy and time in healthcare today.  Honestly, it probably should have always been and not that we didn’t but not with the intensity of what we should have been.  So, what is medication reconciliation? It is the process that you should go through at EVERY encounter in the health system when you are being seen by a health care provider whether in the office, urgent care, emergency room, hospital, nursing facility, rehab or home health care.  It should also be done with every transition in the hospital system (any time you move from one place to another like going from the emergency room to a hospital bed on the medical floor). It is where we document and verify what medications you are taking.  That sounds so simple, right?  Yet amazingly it isn’t always done.  So, what does having medication reconciliation being done does for you?

First, it helps us in the health care system identify if you are on any duplicated medications or classes of medications that might result in harm. Often I will see a patient back who has gone and seen a specialist or other provider like in the emergency room and they may have been started on a new medication that is similar to one they are already taking.  This is not done intentionally or to cause harm, but if the specialist or other provider didn’t have an accurate and complete medication list provided by the patient, they wouldn’t know any different.  It is so important to always have a medication list on your person that you can have to take to your appointments or just available for emergencies.

Second, helps us identify medication changes from your prior visits or encounters so we are informed when making decisions on medication management, monitoring or new medications in treatment. Every time there is a need to modify treatment, your healthcare provider should review what you are taking to make sure whatever is going to be added with fit with what medications you may already be taking or what you may have already tried.

Third, it helps so we can look for drug-drug interactions or drug-condition interactions.  There are many drug interactions that can take place when taking multiple medications.  Some are minor enough that it won’t cause harm but might result in treatment decision modification such as lower dosage that would have been prescribed initially.  Some are severe enough that the drug shouldn’t be prescribed or perhaps another medication stopped.  The drug-condition screen is to look for conditions where the medication dose should be modified or if it is even appropriate to be prescribed at all.  Conditions might include kidney insufficiency or failure, liver disease, certain heart conditions like being too slow or high, having arrhythmias or heart failure, or being diabetic.

Fourth, this is a great time to see if a patient has been compliant with taking a medication and in the correct manner.  This is also not uncommon that a patient may have missed picking up a medication from the pharmacy or they might be taking in the wrong frequency or dosage.  Sometimes patients quit taking their medications on their own and this too needs to be noted to see if there is an area of concern that needs to be addressed; Is it because of side effects, was it too costly, or some other reason.

At the end of the visit, your medication list should be reconciled again prior to leaving your appointment or treatment location.  When this process is complete a new and updated medication list should be provided to you of what medications your health care provider wants you to be taking going forward.  If this was an interaction that took place somewhere besides your primary care provider’s clinic, ideally that provider should be providing your primary care provider with a summary of care as well!

So besides the obvious, why is this so important?  Injuries can be caused by medications frequently.  Whether a duplication has occurred or perhaps you were in the hospital and have heart failure and the provider at the hospital forgot to ‘restart’ your water pills on discharge.  Failure to keep up with your medical needs and appropriate medication needs and failure to communicate that to you can result in harm.  This is also a key reason why it is so important to see your primary care provider in follow up from any hospitalization or stay in a care facility.  Part of that process is us screening your discharge medication list for conflicts in care, omissions of medications that are needed, interactions and duplications from your prior status of care.  This is an easy area to target to help reduce harm in the healthcare system.

Until next time, Pura Vida!

Karen Radley, MD