Figure 1 provides an overview of the processes of medication reconciliation, defined as a “proposed formal, systematic strategy to overcome medication information communication challenges and reduce unintended medication discrepancies that occur at transitions in care.” The figure shows the four best possible sources of information on a patient's medications (patient/family interview, medication vials or lists, government medication database, and the patient's previous health records), which are combined to form a medication history. To this history is added any medications ordered during hospital admission and/or transfer. At the time of discharge, a medication discharge plan is then formulated and communicated as a reconciled list of discharge prescriptions, a physician discharge summary, and a medication schedule. The figure was adapted, with permission, from Pharmacy Practice 2009; 25(6):26, 2009.

Figure 1, Chapter 25Overview of medication reconciliation

Adapted from Pharmacy Practice 2009;25(6):26 with permission

From: Chapter 25, Medication Reconciliation Supported by Clinical Pharmacists (NEW)

Cover of Making Health Care Safer II
Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices.
Evidence Reports/Technology Assessments, No. 211.

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