What is Medication Reconciliation?

Medication reconciliation is the practice of comparing an elder individual’s medication orders to all of the medications that the he or she has actually been taking. This process should encompass five steps:

  1. Creating a comprehensive list of current medications; this list should include all prescription medications, over the counter drugs, herbals & vitamins, and nutritional supplements;
  2. Considering new medications that are indicated for the individual’s situation;
  3. Considering any potential drug interaction between the new prescriptions and the current medication list
  4. Making clinical judgments and changes based on the comparison;
  5. Communicating and ensuring patient understanding of the new medication regimen

Medication Reconciliation ideally should be completed each time there is a transition in setting or level of care, in which new medications orders are written or re-written. For the elderly, this often occurs during hospitalization and discharge home or placement in nursing facilities.

Why is Medication Reconciliation in the Elderly so Important?

Misconduct regarding Medication is a major contributor to emergency hospitalization and nursing home placement. Elderly individuals are generally on more medications than younger patients, to treat diseases and chronic conditions that are more common as we age. They also spend more time in medical facilities and settings addressing those conditions and therefore come into contact with more practitioners who often make changes with every interaction. This higher level of exposure makes them generally more susceptible to errors.  Therefore medication reconciliation is even more important to avoid medication errors and potentially harmful or fatal interactions. This is critical for patients of all ages but can be most harmful for the aging population and can often go easily unidentified or confused for something else such as dementia.

Prescription drug side effects, Dehydration, and Vitamin deficiencies, are all often mistaken as symptoms of Alzheimer’s and other forms of dementia. What compounds this issue is that once the mistake is documented as dementia in an elderly person’s chart, getting it removed is next to impossible and can cause multiple issues down the line, as clinicians see this record in the chart and then make further clinical judgments taking it into consideration. Just because an elderly person exhibits as confused in the hospital does not mean he or she has dementia, and assuming so can be very dangerous.

What can Caregivers do to Aide in the Medication Reconciliation Process?

Most of these issues can be prevented if the provider has the patient’s complete medication list to start with. Bringing a complete list, and even the pill bottles themselves to the hospital with the patient is one way that Caregivers can be proactive in avoiding Medication Reconciliation issues.

Another important action that Caregivers can take is to remain conscientious about disposing old medications. Keeping old pill bottles around increases confusion so it is a good idea to get rid of anything they no longer have to take immediately and make sure it is stricken from their list.

Lastly, never assume the Provider has all of the information. The communication systems amongst hospital systems and other providers are not always as accurate as one would expect, and changes made by the Primary Care physician and other specialists may not be in the systems at all. It is very important to keep your own, up to date master list.

Medication Reconciliation is one of the primary functions of Allegiance’s Extended Care program, a program designed to assist elders in the transition from hospital to home. For more information on this program call us at 703-539-6029.

About the Author: Pam Reynolds, CMC is the President and co-owner of Allegiance Aging Care Services. Pam has spent almost fifteen years working in senior care including long term care facilities and home health care. Her higher education is in Social Work, and she has been credentialed as both a certified Geriatric Care Manager and Licensed Assisted Living Administrator. Read more about Pam and her team of Aging Care Professionals here



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