Friday, June 22, 2012

Medication reconciliation: everyone has a role

ON THE SAME PAGE: Anne Emmerich, MD, at left, talks over a pre-visit form with Jessica Doyle, practice manager for Wang 8 Primary Care Psychiatry.

"Is that the blue one?" a patient asks in response to his physician's inquiry whether he is still taking a certain prescription. With so many medications available Ð in different colors, shapes, sizes, with long names and varying doses - it is easy to be confused.

Medication reconciliation, which is both an MGH policy and a Joint Commission National Patient Safety Goal, is the process through which health care providers help manage and communicate information about multiple medications in order to prevent errors.


Medication reconciliation requires four steps:

  1. Obtain from the patient and document in the electronic medical record a comprehensive, up-to-date, accurate list of medications - including prescription drugs, over-the-counter medicines, vitamins and herbal supplements;
  2. Carefully evaluate the list in the context of the patient's care to address any discrepancies or potential risks;
  3. Educate the patient about their medications; and 
  4. Provide a new list to the patient when chronic medications are added or changed and encourage the patient to share it with other health care providers.

These steps are required in all patient settings where medicine is administered, prescribed or modified and where a patient's response to a treatment or service could be affected by a medication he or she is taking.

"Medication reconciliation is so important because we are continually learning about the medications we prescribe and the interactions they have with other medications," says MGH psychiatrist Anne Emmerich, MD, whose patients are often on multiple psychiatric and nonpsychiatric medications. "It also helps us to be better aware of times when a patient's symptoms may be caused by a medication rather than by a condition. An example of this in psychiatry is when a patient is feeling depressed but is not aware that the pain medication he or she is taking could be the cause."

Everyone has a role in the process -from patients and family members to the physicians who prescribe the medications and the staff who support them. Emmerich credits teamwork in her department for helping ensure medication reconciliation is done properly. "We recently began asking our patients to include all of their medication information on a pre-visit form," she says. "Our support staff have really stepped up to make sure patients fill out these forms."

For more information about medication reconciliation, visit

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