Medication Reconciliation Service
Ensures accurate and complete medication lists across care transitions, preventing medication errors and adverse drug events
Overview
Medication Reconciliation ensures that a patient’s complete and accurate medication list is maintained and reconciled at every care transition, preventing medication errors.
Reconciliation Points
Admission
- Obtain home medication list
- Compare to hospital orders
- Identify discrepancies
- Document intentional changes
Transfer
- ICU to floor
- Between facilities
- Department changes
Discharge
- Compare admission to discharge meds
- Document stopped medications
- Document new medications
- Patient counseling
Medication History Sources
Patient Interview
- Patient/family report
- Medication bottles
- Pharmacy records
- Pill identification
Electronic Sources
- Prescription fill history (SureScripts)
- Prior hospital records
- Health Information Exchange (HIE)
- Insurance claims data
Pharmacy Verification
- Call patient’s community pharmacy
- Surescripts MedicationHistory request
- NCPDP SCRIPT MedicationHistory
Discrepancy Resolution
Common Discrepancies
- Omitted medications
- Dose changes
- Frequency changes
- Stopped medications not documented
- Duplicate medications
Resolution Process
- Discrepancy identified
- Clinical review (pharmacist/provider)
- Intentional change vs error
- Documentation
- Order correction if needed
Technology Stack
- Java, Spring Boot
- Integration with SureScripts
- NCPDP SCRIPT MedicationHistory
- Natural Language Processing (NLP) for free-text parsing
- Clinical decision support integration
Quality Metrics
- Reconciliation completion rate (target: 100%)
- Time to reconciliation (< 24 hours)
- Discrepancy identification rate
- Error prevention (medication errors avoided)