Dec 122011

Groups looking to improve their medication reconciliation process, a critical element of improved care transitions, will find how-to guidance in a just-released Agency for Healthcare Research and Quality toolkit, Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation ( Based on an online toolkit (  developed by Gary Noskin, M.D., and Kristine Gleason, R.Ph., the toolkit offers step-by-step information on how to launch and sustain a standardized medication reconciliation process.

Doing so is an essential element of many patient safety and quality initiatives, including those sponsored or supported by The Joint Commission and the Centers for Medicare and Medicaid. Communication about medications is one of eight key areas covered by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and is a critical element in standards related to meaningful use of electronic health records.

The toolkit authors explain that medication reconciliation involves a complex process of finding discrepancies between a patient’s current medications compared to those included in doctor admission, transfer or discharge orders. Such discrepancies need to be identified and discussed with the provider and patient; if necessary, orders must be revised. The process includes getting a medication list of prescription and non-prescription drugs, either when a patient is admitted or seen; considering these medications when ordering new medications or continuing treatment; verifying discrepancies; and providing an updated list and communicating its importance to the patient and caregiver.

Groups can use the toolkit to evaluate their existing processes and to identify and respond to gaps in them. It offers strategies for standardizing the process for physicians, nurses, and pharmacists, emphasizing the need for clearly defined roles and responsibilities. A standardized process can ensure that the most accurate and complete documentation is developed for each patient, that inpatient and home medications are reconciled, and that information is available to the entire health care team.  

The guide features seven sections covering topics that range from how to encourage facility leadership to support a medication reconciliation endeavor to how to recognize and manage high-risk situations.

Key words: medication reconciliation, discharge planning, care transitions, patient safety