Medication Reconciliation: A Case Study

The Institute for Safe Medication Practices Canada (ISMP Canada) defines medication reconciliation as “a formal process in which healthcare providers work together with patients, families and care providers to ensure accurate and comprehensive medication information is communicated consistently across transitions of care.”1 It is based on “a systematic and comprehensive review of all the medications were taking by patient and to ensure that medications being added, changed or discontinued are carefully evaluated. Medication reconciliation has been endorsed by patient safety organizations and implemented in many institutions around the world to ensure accurate communication on admission, on transfer, and at discharge

Medication errors are common when patients transfer across healthcare boundaries (McCullagh M, O'Kelly P, Gilligan P. 2015)
More than 40% ofmedication errors can be traced to inadequate reconciliation (Monte AA1, Anderson P2, Hoppe JA3, Weinshilboum RM4, Vasiliou V2, Heard KJ3, 2015)

Medication errors are among the most common medical errors, and they may be related to professional practice, health care products and system, including prescribing, order communication, product labeling, packaging and compounding, dispensing, distribution,
Among these include the limited medical literacy of patients, communication between providers and teams of providers, and the intrinsic difficulties of medical charting (Siu HK, 2015).

Previous research has shown that many older adults without known cognitive impairment are unable to recall basic knowledge about their medical history due to memory difficulties. Clinicians treating older adults should be very cautious before relying on their patients' memories for accurate recall of their medical conditions, their drug regimens, and even the number of drugs they are taking. (Jones G1, Tabassum V, Zarow GJ, Ala TA,