What is medication reconciliation and when should it be performed?

• A. The process of comparing a patient’s current meds with new orders at admission, transfer, and discharge.
• B. A simple list of medications at discharge.
• C. Inventory check of all meds in the pharmacy.
• D. Reporting adverse events only.

Answer: (A)

Medication reconciliation is the deliberate process of making sure a patient’s medication information is accurate and complete as they move through different care settings. It involves comparing what the patient is actually taking (prescriptions, over-the-counter meds, and supplements) with what is ordered in the hospital at admission, during transfers between units, and at discharge. The goal is to identify and resolve discrepancies such as omissions, duplications, incorrect doses, or contraindicated drugs, and to update the medication list and the MAR so every clinician uses the same correct information. This practice reduces the risk of adverse drug events and ensures continuity of care by clearly communicating changes to the patient and the next care team. In daily practice, a unit clerk might help collect the patient’s current med history, verify it against orders, document reconciled changes, and ensure the discharge med list accurately reflects what the patient should take home.