What Is Medication Reconciliation Explained Simply

Medication reconciliation is one of those fundamental safety checks in healthcare. Think of it as creating the single most accurate, up-to-date list of every single medication a patient is taking—and then comparing that list against what a doctor is ordering during admission, transfer, or discharge. This process isn't just about ticking a box; it's a dynamic, critical thinking exercise that serves as a cornerstone of patient safety. The primary objective is to prevent adverse drug events (ADEs) by ensuring that every healthcare provider, along with the patient, is on the same page regarding medications.

This isn't just about prescriptions. It’s a full accounting of everything: over-the-counter drugs, vitamins, and even herbal supplements. The goal is simple but critical: prevent medication errors before they happen. In a healthcare system that is increasingly complex and fragmented, medication reconciliation acts as the vital thread that connects different phases of a patient's care journey, ensuring continuity and safety from the hospital to the home and back again.

Understanding Medication Reconciliation

Picture a patient’s medication list as the blueprint for their care. If that blueprint is wrong—missing a key detail or including an outdated one—the entire structure is at risk. Medication reconciliation is the process of reviewing and verifying that blueprint to make sure it's perfect. It is a systematic process that includes developing a comprehensive list of all current medications, reconciling it against physician admission, transfer, and/or discharge orders, and documenting any changes.

This becomes absolutely essential during any transition of care. When a patient is admitted to the hospital, moved to a different unit, or sent home, the risk of a miscommunication skyrockets. These transitions are notorious weak points in the healthcare system where information can be lost, misinterpreted, or overlooked. This process acts as a crucial safety net, ensuring the medication plan remains consistent and safe at every step. It’s less about paperwork and more about proactive communication, critical analysis, and collaborative patient care.

The Core Purpose of This Safety Check

At its heart, medication reconciliation is all about preventing patient harm. So many medication errors—like omissions, duplications, dosing mistakes, or dangerous interactions—happen simply because of information gaps. This process is designed specifically to close them. When performed correctly, it can significantly reduce the incidence of adverse drug events, which are a major cause of morbidity and mortality in hospitalized patients and are often preventable.

The Joint Commission frames it as a formal comparison between what a patient is currently taking and the medication orders a physician writes. This structured review is vital whenever a patient's care setting or provider changes. The emphasis is on creating a single, authoritative "source of truth" for a patient's medication regimen that all members of the care team can rely on.

To put it simply, here’s a breakdown of what medication reconciliation aims to achieve.

The Core Purpose of Medication Reconciliation at a Glance

By focusing on these core goals, medication reconciliation moves from being a simple task to a high-impact safety strategy.

Bridging Gaps in a Fragmented System

Today’s healthcare is rarely simple. A patient often sees multiple specialists, uses different pharmacies, and moves between hospitals and outpatient clinics. Each stop along the way can create a new, slightly different medication list, leading to a confusing and fragmented history. This is a huge reason why interoperability in healthcare is such a hot topic. Without seamless data sharing, the burden of creating a unified medication history falls on manual reconciliation processes.

Medication reconciliation is the formal process of creating the most complete and accurate list possible of a patient's current medications and comparing it to those in the patient record or medication orders.

This process is essentially detective work. It involves piecing together scattered information to create one clear, coherent picture of what the patient is actually taking. It requires a clinician to sift through EHR data, pharmacy records, patient interviews, and previous discharge summaries. It irons out the discrepancies that pop up when one clinic’s EHR doesn’t talk to another’s, or when a patient simply forgets to mention a supplement they buy online. This diligent investigation is what transforms a collection of disparate data points into a reliable clinical tool.

Ultimately, it ensures that every clinical decision is grounded in complete and correct information. That’s the bedrock of safe and effective medical care.

The Five Steps of Effective Medication Reconciliation

To really get a handle on medication reconciliation, it’s best to see it as a sequence of deliberate actions, not just a single checkbox on a form. It's a structured, five-part process where every detail matters. Each step logically flows into the next, creating a safety net designed to catch problems before they can cause any harm. The rigor of following these steps consistently is what transforms the process from a theoretical ideal into a practical, life-saving intervention.

Think of it like building a complex piece of furniture—you can't just skip ahead to the final step. You have to follow the instructions carefully, in order. If you miss a step or get one wrong, the whole thing could fall apart. The same holds true here; precision at every stage is what keeps patients safe. Rushing or cutting corners in any of these steps undermines the integrity of the entire process and reintroduces the very risks it was designed to mitigate.

Let’s walk through the five core steps that make this process work, using real-world examples to see them in action.

Step 1: Create the Comprehensive List

First things first, we need to build the foundation: the Best Possible Medication History (BPMH). This isn’t a quick glance at the patient's chart. It’s a full-blown investigation to create a master list of every single thing the patient is taking. The BPMH is considered the gold standard for medication history collection and is far more detailed than a routine list.

And by everything, we mean everything:

• Prescription Medications: Every drug prescribed by any doctor, including details on dose, route, frequency, and last dose taken.
• Over-the-Counter (OTC) Products: Think pain relievers, allergy pills, or antacids. These often go unreported but can have significant interactions.
• Vitamins and Supplements: Any herbal products, vitamins, or minerals. Products like St. John's Wort or Ginkgo Biloba can have serious drug interactions.
• As-Needed Medications: Things taken only for specific symptoms, like an inhaler for asthma attacks or a pill for migraines. Understanding the frequency of use is key.
• Topical preparations, eye drops, and occasional injections: These are also frequently forgotten but are an important part of the complete picture.

To get this list right, you must use at least two sources. You might talk with the patient and their family, call their local pharmacy for a fill history, review notes from past hospital stays, and consult the state's prescription drug monitoring program (PDMP). The mission is to get a complete, 360-degree view, leaving no stone unturned.

Step 2: Develop a List of New Medications

With that comprehensive "at-home" list complete, the next job is to create a second one. This new list will contain all the medications the doctor plans to order for the patient right here, right now, based on the current clinical context. This is the "post-transition" list.

For instance, a patient admitted for pneumonia will probably get new orders for antibiotics and other supportive care. The admitting physician creates this list based on their diagnosis and clinical plan. This list is not created in a vacuum; it should be informed by the BPMH gathered in Step 1. However, at this stage, it exists as a separate set of proposed orders.

This step is all about establishing a clear "before" and "after" picture. One list shows what the patient walked in with, and the second shows what the new game plan is.

Having these two distinct lists is what sets the stage for the most critical part of the process: the comparison. This clear separation prevents assumptions and forces a deliberate review of every single medication.

Step 3: Compare the Two Lists

This is where the real detective work happens. A clinician—often a pharmacist, nurse, or physician—sits down and meticulously compares the patient's home medication list (from Step 1) with the newly ordered medication list (from Step 2). The entire goal is to spot any and all discrepancies. This line-by-line comparison is the core of the reconciliation.

A discrepancy is simply any difference between the two lists. Some are intentional, of course, like holding a blood pressure pill before surgery. But many are unintentional—and those are the ones that can be dangerous. Discrepancies must be identified, documented, and then investigated.

Common discrepancies we find here include:

• Omissions: A critical medication the patient takes at home was forgotten on the new order list. For example, an anti-seizure medication is missed, which could lead to a breakthrough seizure.
• Duplications: The same drug (or one from the same family) is on both lists, raising the risk of an overdose. This can happen with different brand and generic names.
• Dosing Errors: The dose or frequency is different from what the patient normally takes, with no clear reason for the change.
• Drug Interactions: A newly prescribed medication could interact badly with something on the patient's home list.
• Contraindications: A newly ordered drug may be inappropriate given the patient's current condition (e.g., kidney function) or other medications.

This side-by-side review is the heart of medication reconciliation. It's what makes it such a powerful safety tool.

Step 4: Make Clinical Decisions

Spotting a discrepancy is only half the job. Now, the clinician has to dig into each one and decide what to do about it. This step is all about critical thinking and clear communication. It involves contacting the prescribing physician to clarify intentions and resolve any issues.

For example, if a patient’s cholesterol medication was left off the hospital orders, the clinician has to ask why. Was it a deliberate choice? Or just an oversight? The provider has to clarify the reason and fix the orders if it was a mistake. If a dose was changed, that decision needs to be clearly documented. This stage is a key part of the patient's record, and a good progress note template often includes a specific section for these updates and the rationale behind them.

Every single discrepancy is addressed until the new medication list is 100% verified and accurate. The result is one unified, correct list of what the patient should be taking during this phase of their care.

Step 5: Communicate the Final List

The last step is arguably the most important: communication. A perfectly reconciled medication list does no good if it stays locked away in the chart. It has to be shared with everyone involved in the patient's care, especially the patient themselves. This final communication loop is what ensures the safety benefits of reconciliation are fully realized.

This involves a few key actions:

1. Educating the Patient: The clinician sits with the patient and their family to go over the final list, explaining any changes and why they were made. They need to confirm the patient understands what to take, when to take it, and what to stop taking.
2. Updating the Record: The final, reconciled list is documented clearly in the patient's official medical record, becoming the new "source of truth."
3. Informing the Next Provider: When the patient moves to another unit or is discharged, this clean list is handed off to the next person responsible for their care—be it their family doctor, a specialist, or a home health nurse. This is often done via a detailed discharge summary.

This final handoff ensures a safe transition and closes the information gaps where errors so often happen. By closing the loop, all the hard work of reconciliation pays off in real, tangible patient safety.

Why This Process Is Crucial for Patient Safety

It's one thing to know the steps of medication reconciliation, but it's another thing entirely to grasp why it’s a non-negotiable part of modern healthcare. This isn’t about ticking boxes or administrative busywork. It's a fundamental pillar of patient safety—the last line of defense between effective treatment and a potential disaster. Without this process, we are essentially navigating patient care with an incomplete or faulty map.

The real-world consequences of a simple medication oversight can be devastating. Imagine a patient on a blood thinner at home is admitted to the hospital. If there's a communication breakdown, they might be prescribed a second, different blood thinner. This seemingly small mistake could easily lead to a life-threatening bleed. Medication reconciliation is the safety net designed to catch exactly these kinds of dangerous overlaps. It transforms assumptions into certainties.

At its heart, this process is a critical strategy to prevent medication errors and safeguard patient well-being. It turns a fragmented list of prescriptions into a single, unified care plan.

The High Cost of Miscommunication

Transitions of care are notoriously risky. Whether a patient is moving from home to the hospital, from the ICU to a regular floor, or back home again, these moments are when information is most likely to get lost or misinterpreted. These junctures represent points of vulnerability where continuity of care can break down completely.

The statistics are jarring. Roughly 50% of all medication errors in hospitals and 20% of adverse drug events can be traced back to poor communication during these transitions. The landmark 1999 Institute of Medicine report, 'To Err Is Human,' identified medication errors as the most common mistake in healthcare, contributing to thousands of deaths and billions in costs annually. More recent studies continue to highlight this vulnerability, confirming that inadequate medication reconciliation remains a leading cause of preventable patient harm.

This data tells a crucial story: an accurate medication list isn't a "nice-to-have." It's an essential tool for protecting patients from completely preventable harm.

Building a Foundation of Trust

Beyond just preventing physical harm, a thorough medication reconciliation process builds something just as vital: trust. When patients see their care team taking the time to carefully go over their entire medication history, it sends a clear message of commitment to their well-being. It demonstrates thoroughness, attention to detail, and a patient-centered approach.

This simple act of diligence reassures patients that they are being treated as a whole person, not just a set of symptoms. It fosters a more collaborative environment where people feel comfortable sharing vital information, which in turn leads to greater accuracy and better outcomes. This engagement is crucial, as patients are the ultimate experts on their own medication-taking behaviors and history.

By verifying every medication, every single time, healthcare providers send a powerful message: "Your safety is our top priority." This consistent action is one of the most effective ways to strengthen the patient-provider relationship.

This dedication to getting it right is a cornerstone of any effort toward quality improvement in healthcare. It is a tangible demonstration of a commitment to high-reliability care.

Reducing Preventable Hospital Readmissions

A shocking number of hospital readmissions are tied directly to medication issues that crop up after a patient goes home. They might be confused about which prescriptions to continue and which to stop, or get conflicting instructions from different doctors. These post-discharge medication discrepancies are a major driver of adverse events that lead to costly and often avoidable readmissions.

A solid medication reconciliation process, especially at discharge, tackles this problem head-on by making sure patients leave with a clear, easy-to-understand plan. This is often the final and most critical reconciliation point.

A successful discharge reconciliation always includes:

• A Plain-Language List: Giving the patient a written list of their medications, what each is for, the exact dose, and when to take it. Avoid medical jargon.
• Clear Instructions on Changes: Explicitly highlighting which medications have been stopped, started, or had their dosage changed, and briefly explaining why. This helps patients understand the rationale behind the new plan.
• Confirming Understanding: Using the "teach-back" method—asking the patient to explain their medication plan back to you—to make sure they truly get it. This is a proven technique for verifying comprehension.
• A Plan for Follow-up: Ensuring the patient knows who to call if they have questions and has a follow-up appointment scheduled with their primary care physician to review the plan.

By closing these communication gaps, hospitals can dramatically lower the chances of a patient ending up right back in a hospital bed because of a preventable medication mistake.

Overcoming Common Roadblocks in Reconciliation

While the five steps of medication reconciliation sound straightforward, applying them in the real world is often anything but. The fast-paced, high-pressure environment of a hospital or clinic throws up all sorts of hurdles that can turn a simple safety check into a complex puzzle. These barriers are not insurmountable, but they require proactive strategies and a commitment from the entire healthcare organization.

Clinicians on the front lines deal with this every day. You might be working with unreliable information, trying to make sense of fragmented data systems, or simply running out of time. But here’s the thing: understanding these roadblocks is the first step to beating them. These aren't just abstract problems; they're practical issues that demand practical solutions. Recognizing these challenges allows for the development of targeted interventions to improve the process.

Let’s dig into the most common obstacles you'll face and talk about how to navigate them.

Dealing With Inaccurate Patient Histories

One of the biggest hurdles is getting a truly accurate medication list from the patient. It’s a constant challenge. Patients might be cognitively impaired, too sick to think clearly, or simply forget a medication they’ve been taking for years. And they almost never think to mention the over-the-counter supplements or that one-off prescription they got from a specialist. This reliance on patient memory, which can be fallible under the best of circumstances, is a significant weak point.

This is where clinicians have to put on their detective hats and use multiple sources to piece together the full picture. A single source of information is never sufficient.

Here are a few proven strategies:

• Talk to the Family: A spouse, child, or caregiver is often a goldmine of information. They can fill in the gaps and provide a more complete history.
• Call the Pharmacy: The patient's regular pharmacy can provide a recent fill history, which is usually far more reliable than memory alone. This can reveal non-adherence or use of multiple pharmacies.
• Use the "Brown Bag" Method: This is a classic for a reason. Ask the patient or their family to bring in all their medication bottles—prescriptions, vitamins, supplements, everything—for you to review directly. This allows you to check dosages, fill dates, and prescriber information firsthand.
• Consult External Databases: Utilize health information exchanges (HIEs) or the state's Prescription Drug Monitoring Program (PDMP) to gather a more complete electronic record.

Using this multi-source approach gives you a much more solid foundation for the entire reconciliation process.

Navigating Discrepant Electronic Health Records

In a perfect world, every electronic health record (EHR) would talk to every other system seamlessly. In reality, that’s rarely the case. EHRs from different hospitals, clinics, and pharmacies often don't communicate well, leaving you with conflicting or outdated medication lists. The list from a specialist's office might be completely different from the one generated during a recent hospital stay. This lack of interoperability is a major systemic barrier.

It happens all the time: a patient hands you a neatly printed list of their medications, but the hospital's electronic system shows something else entirely. Technology doesn't solve this problem on its own; it still requires sharp clinical judgment.

When you run into these discrepancies, the golden rule is to never assume one source is automatically correct. The patient’s self-reported list, the pharmacy’s data, and the EHR are all just clues. Your job is to investigate the differences and find the single source of truth, usually by clarifying directly with the patient or their pharmacy. Treat every list as a starting point for verification, not a final answer.

Managing Time Constraints in a Busy Setting

Maybe the most relentless challenge is time. In a chaotic emergency department or a packed clinic, it can feel next to impossible to dedicate the necessary minutes to a thorough med rec for every single patient. The pressure to keep things moving can lead to this crucial step being rushed or, even worse, skipped entirely. This is where process design and team roles become critical.

The key to managing this is building efficient workflows and empowering a team-based approach, where everyone plays a part. For example, a trained pharmacy technician could be responsible for gathering the BPMH, freeing up nurses and pharmacists to focus on the comparison and clinical decision-making steps.

With that in mind, let's look at a few common pitfalls that crop up during medication reconciliation and, more importantly, how you can avoid them.

Common Pitfalls in Medication Reconciliation and How to Avoid Them

The following table breaks down some of the most frequent mistakes we see in practice and offers simple, effective ways to keep them from happening.

By being aware of these common slip-ups and having a plan to address them, you can make sure medication reconciliation remains a powerful tool for keeping patients safe, even on the busiest of days.

How to Weave Reconciliation into Your Daily Workflow

Having a solid process on paper is a great start, but the real challenge is making medication reconciliation a consistent habit. The goal isn't just to add another task to a busy day; it's to weave this crucial safety check into the very fabric of clinical practice until it feels second nature. This requires a dedicated, team-based approach where everyone knows their part and understands the "why" behind their actions. It needs to be integrated, not just appended.

Whether you're in a chaotic emergency room or a scheduled outpatient clinic, successful integration will look a little different. But one thing is constant: it has to be a shared responsibility. When nurses, physicians, and pharmacists work together, the whole process gets smoother, faster, and—most importantly—far more accurate. Leadership support and a culture of safety are essential for this integration to succeed.

Defining Roles for a Cohesive Team

A strong medication reconciliation program hinges on clear roles. Think of it like a well-drilled relay team. Every runner has a specific job, and a clean handoff is the only way to win. While it’s a team effort, assigning primary responsibilities ensures nothing gets dropped. Vague roles lead to duplicated effort or, worse, tasks being missed entirely.

Here’s how duties are often broken down:

• Nurses or Pharmacy Technicians are typically on the front lines. They’re usually the ones gathering the initial Best Possible Medication History (BPMH) when a patient is admitted. Their direct patient contact is invaluable for getting the full story.
• Pharmacists can then step in to review that list. With their deep expertise, they're perfectly positioned to spot potential drug interactions, dosing errors, or therapeutic duplications. They are the medication experts and are crucial for verifying complex regimens.
• Physicians and Prescribers are the final decision-makers. They use the verified list to make safe, informed choices, ensuring any new orders make sense with the patient’s complete medication profile. They are responsible for resolving discrepancies and signing off on the final, reconciled list.

This division of labor keeps any one person from getting buried and plays to the unique strengths of each team member.

Using Technology as a Workflow Ally

Modern tech can be a huge help in making medication reconciliation more efficient. Electronic health records (EHRs), when used right, can automate a lot of the initial legwork by pulling in medication histories from pharmacies or other health systems. This gives clinicians a fantastic starting point. Features like automated dose range checking and allergy alerts can provide an additional layer of safety.

But technology is a tool, not a replacement for clinical judgment. Even the most sophisticated system can have errors or outdated info. Automated alerts can flag potential problems, but a trained human must always make the final call. The Institute for Healthcare Improvement drives this home by emphasizing that the heart of the process is still a human comparing a verified list with prescribed treatments to resolve discrepancies. You can learn about successful implementation from global health studies to see more on this.

Technology streamlines the 'what'—the data gathering. But the clinical team must always provide the 'why'—the critical thinking that ensures patient safety.

Finding that sweet spot between automated support and human oversight is what makes a reconciliation system truly reliable.

Making Reconciliation a Habit Through Training and Audits

Turning any process into a daily habit requires reinforcement. A one-off training session just won't cut it. To really get this right, you need ongoing education and regular feedback to keep skills sharp. This includes training on communication techniques like motivational interviewing to elicit better patient histories. Innovative methods like virtual reality medical training can be incredibly effective here, allowing staff to practice tough scenarios in a safe, controlled environment.

On top of that, regular audits are non-negotiable for maintaining high standards. Periodically reviewing a sample of patient charts helps you see what's working well and pinpoint where the process might be breaking down. These audits should measure key metrics, such as the rate of unintentional discrepancies or the percentage of patients receiving discharge counseling.

Consider these practical steps:

1. Standardize Your Forms: Create one consistent template for gathering medication histories that everyone uses, no matter the department. This ensures all necessary data points are collected every time.
2. Embed Reconciliation in Handoffs: Make it a required checklist item during the verbal report when a patient is transferred or discharged.
3. Provide Regular Feedback: Share audit results with the team in a non-punitive way. The goal isn't to point fingers but to find opportunities for improvement and celebrate what's going right.
4. Involve Patient Advocates: Include patient representatives in the design and review of your reconciliation process to ensure it is patient-friendly and effective from their perspective.

By building these practices into your daily operations, medication reconciliation stops feeling like a chore and becomes what it should be: a seamless, life-saving part of everyday patient care.

Common Questions About Medication Reconciliation

Even when the process seems straightforward on paper, a lot of questions pop up in the real world—both for clinicians and patients. Getting clear on these points is the key to making medication reconciliation less of a chore and more of a powerful safety tool. Addressing these common queries can help demystify the process and improve buy-in from all stakeholders.

Let’s tackle some of the most common questions head-on to build everyone's confidence in the process.

Who Is Responsible for Medication Reconciliation?

This is a classic point of confusion, but the answer is surprisingly simple: it's a team effort. While one person might start the process, the responsibility for getting it right is shared across the entire care team. Accountability rests with the organization to provide a clear, well-designed process, but the responsibility for executing it lies with every clinician involved in the patient's care.

Think of it like building a house. A nurse might lay the foundation by getting the initial medication history from the patient. Then, a pharmacist acts as the inspector, reviewing the plans to make sure there are no dangerous conflicts or structural weaknesses (like drug interactions or dosing errors). Finally, the physician, as the architect, makes the final decisions on the blueprint, prescribing the medications that will be used going forward.

The best systems create a culture where everyone feels responsible for safety. When the whole team—including the patient and their family—is empowered to raise a hand and say, "Wait, that doesn't look right," you get a much more accurate medication list.

And never forget, the patient is the most important person on that team. They're the only ones who know for sure what they're actually taking at home.

When Should Medication Reconciliation Be Performed?

Timing is everything. Medication reconciliation is absolutely critical during any transition of care, which is just a fancy way of saying "anytime a patient moves from one healthcare setting to another." These are the moments when wires get crossed, communication breaks down, and mistakes happen. It is not a one-time event but a continuous process that should be revisited at every high-risk juncture.

You should always perform reconciliation at these key moments:

• Upon Hospital Admission: This creates the "source of truth" for the entire hospital stay. Getting it right here prevents a cascade of downstream errors.
• When Transferring Between Units: A patient moving from the ER to a medical floor or from the ICU to a regular room is a major handoff. Their condition has changed, and their meds likely have, too. Reconciliation must be done again.
• At Hospital Discharge: This is arguably the most important one. A patient going home needs a crystal-clear, accurate, and easy-to-follow medication plan. A solid discharge reconciliation is one of the best ways to prevent them from bouncing right back to the hospital.
• Entering a New Care Setting: This also includes moving into a nursing home, starting with a home health agency, or even just seeing a new specialist for the first time in an ambulatory setting.

Each of these points is a high-risk handoff where this formal safety check is a must.

How Can Patients Help Make the Process Accurate?

Patients and their families are your number one allies in this process. When they're engaged, the accuracy of the medication list skyrockets. The single most powerful thing a patient can do is come prepared. Empowering patients to be active participants is a key strategy for success.

Here are a few simple but incredibly helpful things patients can do:

1. Keep an Up-to-Date List: This means everything you take—the drug name, the dose (like 20 mg), how often you take it, and why. Note the last time each medication was taken.
2. Include Everything: Don't just list prescriptions. Add in over-the-counter stuff like aspirin or allergy pills, plus all vitamins, supplements, and herbal remedies.
3. Bring It With You: Keep the list in your wallet or on your phone and bring it to every single appointment, ER visit, or hospital stay. No exceptions.
4. Try the "Brown Bag" Method: If a list feels like too much, just throw all your medication bottles (prescriptions, vitamins, everything) into a bag and bring it with you. This lets the clinical team see exactly what you have.
5. Ask Questions: Patients should feel empowered to ask "What is this medication for?" and "How is this different from what I was taking at home?"

When patients take these steps, they become active partners in their own safety, not just passive recipients of care.

What Is the Difference Between Medication Reconciliation and Medication Review?

This is a great question because the terms sound almost identical, but they describe two very different jobs with different goals. Both are important for medication safety, but they are distinct processes.

Think of it this way:

Medication reconciliation is like taking inventory. You're simply making a list of every medication a patient is taking and comparing it to what's been ordered to make sure nothing is missing, duplicated, or written down wrong. The goal is accuracy. It is a task-oriented process focused on preventing transcription errors.

• Medication Reconciliation: Is the list correct? It’s a safety check focused on preventing errors like omissions and duplications during care transitions.

A medication review, often called medication therapy management (MTM), is more like a strategic analysis. A clinician (often a pharmacist) looks at that accurate list and asks bigger questions: Are all these drugs still necessary? Is this the best dose for the patient's current condition? Are there any side effects we can fix? Could we stop any of these? The goal is appropriateness. It is a cognitive, clinical service aimed at optimizing the patient's entire drug regimen.

• Medication Review: Are these the right medications for this patient right now? It’s a clinical assessment focused on optimizing therapy to get the best possible health outcomes.

So, in a nutshell: reconciliation ensures the list is right, while a review ensures the meds on the list are the right ones. You must perform reconciliation first to create the accurate list needed to conduct a meaningful review.

At Simbie AI, we know that an accurate medication history is the foundation of patient safety. Our clinically-trained voice agents are built to help healthcare practices by gathering detailed and precise patient histories, which is the first and most critical step in building an accurate medication list. By handling this essential data collection, we free up your clinical team to focus on the high-level analysis and decision-making that keeps patients safe. Learn how our AI-powered support can strengthen your practice at https://www.simbie.ai.