D u k e Details - Advanced Clinical Practice - Duke University

sAccurately and Completely ReconcileMedications Across the Continuumof CareMedication reconciliation is the process ofcomparing the patient’s current list of prescribedmedications against the medications received inthe previous care setting when a patient is admitted,transferred from one level of care or service toanother, discharged or on outpatient encounter,including settings where medications are minimallyused or used for short durations.On inpatient admission:• The nurse & prescriber collect and documentcomplete medication histories independently.• The pharmacist compares medication historiesagainst one another and admission orders andreconciles discrepancies with the prescriber.• On transfer, reconciliation occurs with acceptanceof transfer orders. Transfer is anytimethe patient changes service, setting, provideror level of care and new medication ordersare written.• On discharge, the focus is on reconcilingthe pre-admission list and inpatient list.Communicate a complete current medicationlist to the patient and to the next care providerat discharge.On outpatient encounter, the intake person• Reviews and modifies patient medication list.• The physician reviews with the patient andupdates medications as needed.• Communicate a complete medication list tothe patient and the next care provider at theend of the encounter.National Patient Safety Goals11