6 The Institute for Healthcare Improvement (IHI) has medication reconciliation as part of its 100,000 Lives Campaign. The Joint Commission added medication reconciliation across the care continuum as a National Patient Safety Goal in 2005. The intent is to avoid errors of omission, duplication, incorrect doses or timing, and adverse drug-drug or drug-disease interactions. Recognizing vulnerabilities for medication errors, numerous efforts are underway to encourage all health care providers and organizations to perform a medication reconciliation process at various patient care transitions. This process comprises five steps: (1) develop a list of current medications (2) develop a list of medications to be prescribed (3) compare the medications on the two lists (4) make clinical decisions based on the comparison and (5) communicate the new list to appropriate caregivers and to the patient. Transitions in care include changes in setting, service, practitioner, or level of care.

It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. Medication reconciliation is a formal process for creating the most complete and accurate list possible of a patient’s current medications and comparing the list to those in the patient record or medication orders. 3, 4 Many of these errors would be averted if medication reconciliation processes were in place. 3 Of these errors, about 20 percent are believed to result in harm. 2 More than 40 percent of medication errors are believed to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients. This confirms previous research findings that medication errors represent the most common patient safety error. According to the Institute of Medicine’s Preventing Medication Errors report, 1 the average hospitalized patient is subject to at least one medication error per day.