Medication Reconciliation: a practice to avoid prescriptions errors, in and outside of the hospital

The reconciliation of pharmacological treatments [is known as Medication reconciliation] can become a new ally for patients with chronic diseases! Behind this complicated topic lies a practice that is not yet widespread, but that is very useful for improving patient care. The purpose of medication reconciliation is to ensure the most accurate list possible of all medications a patient is taking is compiled; compare that list against the physician’s admission, transfer, or discharge orders; ensure that the appropriate treatments have been prescribed during each stage of the patient's health care protocol; and avoid medication errors. Medication reconciliation is especially useful when the patient enters or leaves the hospital, since it is not followed by the same doctors as daily.

The sharing of the right information among health professionals

This approach was first mentioned in 2006 by the World Health Organization. According to the official definition, its objective is to encourage and facilitate the transmission and exchange of complete and accurate information about patient treatments among health professionals at each stage of care.¹ By sharing the right information, health professionals can identify and avoid medication errors. Indeed, prescriptions can be complex when a patient is required to take several! In this way, reconciliation guarantees the continuity and safety of pharmacological treatments. With medication reconciliation, there is less risk that an error or omission will interrupt the prescription or follow-up in the hospital.

Correct errors from one prescription to another

More specifically, let's take the example of a patient entering a hospital. The hospital pharmacist may decide to conduct a medication reconciliation to to be certain of the medical care of this patient. To do this, the pharmacist should review at least three different sources, such as the patient, the patient’s retail or community pharmacy/pharmacist, the patient’s attending physician, the patient’s caregivers, the patient’s medical specialists, etc. Medication reconciliation allows the hospital pharmacist to review, as completely as possible, the treatments taken and being taken by a patient. The hospital pharmacist will compare this evaluation with the prescription written by the hospital doctor upon entering the hospital. Then, the hospital pharmacist will be able to identify any changes and/or recommendations that the hospital doctor can make for optimal patient care.

Where are medication reconciliations carried out?

Medication reconciliations can be carried out in the hospital, but also in a pharmacy outside of the hospital, such as a retail or community pharmacy. The aim of medication reconciliation is try and establish the link between the various health professionals involved in the care of a patient, as well as the link between the medical care within and outside of the hospital: the reconciliation often occurs at the beginning of the hospital stay, in order to ensure patient care is appropriate during a patient's stay.

All health professionals (doctors, pharmacists, etc.) can practice the concept of medication reconciliation. However, it is an activity that requires a lot of time and attention; however, its practice is not yet widespread. Germany, the United Kingdom, France, and the United States in particular have participated in this practice.

Can I benefit from medication reconciliation?

In theory, any patient’s medication history can be reconciled, since it is a systematic and protocolized process. However, because it takes time, patients with the highest risk of medication errors are the first that should benefit. These patients often have several conditions/pathologies and take a large number of medications a day: they are the ones that need this form of reconciliation the most.

It is not yet possible to directly request a reconciliation of pharmacological treatments, but the practice is expanding. In Canada, for example, almost all hospitalized patients benefit from medication reconciliation. It is hoped that Spain will be inspired by these techniques to ensure that as many patients as possible benefit from them.

The role of the patient: the first source of information

During medication reconciliation, the important thing for the hospital pharmacist, or any other health professional, is to be able to collect valid information. In order for a patient to be able to provide reliable information in the event of having to participate in a medication reconciliation, the individual must be familiar with the her/his treatments. 

At a minimum, it is essential for individuals to keep valid prescriptions in order to present them. In general, it is recommended, depending on the severity and fluctuation of the patient's pathologies, for an individual to carry recent health documents in case of a medical emergency or hospitalization.

Are you familiar with medication reconciliation? Have you ever benefited from it or experienced medication errors?

Share your experience regarding medication reconciliation and medication errors in the comments!