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Medication Reconciliation and Patient Safety Outcome

Medication reconciliation is  the process for creating  and  initiation the most complete and the  accurate list possible of a patient’s with current medications and comparing the list to those in the patient  medical record or medication orders that According to the Joint Commission.Medication reconciliation is the process of the comparing a patient's medication orders to all of the medications that the patient has been taking medicine. This reconciliation is done to avoid medication errors such as dose or medication omissions,  therapeutic duplications , inappropriate dosing, or drug - drug interactions. It should be done at every transition of care in which new medications are ordered by prescriber  or existing orders are re ordered , Transitions in care include changes in  the care setting,  the service provided , practitioner, or level of care. The steps in medication reconciliation are the following for a newly hospitalized patient, the steps include obtaining and verifying the patient’s medication history prior to admission, documenting the patient’s medication history, writing the medication orders for the hospital medication regimen that clinically needed to patient, and creating a medication administration record. At discharge, the steps include determining the post discharge medication regimen, developing discharge instructions for the patient for home medications, educating and counseling the patient, and transmitting the medication list to the follow-up physician. For patients in ambulatory settings and outpatient, the main steps include documenting a complete list of the current medications and then updating the list whenever medications are added or changed and the list shall be given to patient.

Author(s): Fatima Yousef Ali Ghethan

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