Medication Reconciliation

The implementation of our electronic health record is Ministry Health Care’s largest and most important patient safety and quality of care initiative.  Perhaps the largest improvement in patient safety will occur with improvements to our medication list allowing easier and more complete medication reconciliation.

Over the years, I have become convinced a patient’s outpatient current medication list just cannot be accurate without a total commitment to electronic prescribing.  Without an accurate medication list, medication reconciliation at every clinical encounter becomes very difficult to achieve.

Medication reconciliation has become the standard within the hospital setting but is just now gaining momentum in the outpatient world.  Though most clinicians are reluctant to admit it, most of the time we are not 100% sure what medications the patient is taking. Patients often take medications differently than prescribed or are taking medications prescribed by other clinicians.  Pharmacies convert prescriptions from trade name to generic medications further adding to the confusion.  I have frequently found patients taking both the generic and trade name version of the same drug thinking they were actually taking different medications, not a double dose of the same medication. You will not reliably know what medications a patient is taking without a specific process of medication reconciliation that includes a monitoring for accuracy.

The electronic health record will allow us to have a single enterprise wide medication list that will be used for medication reconciliation at every outpatient clinical encounter and admission/discharge from our hospitals.


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