Medication Reconciliation Review

Luther Midelfort — Mayo Health System
Eau Claire, Wisconsin, USA


The Medication Reconciliation Review tool provides step-by-step instructions for conducting a review of closed patient records to identify errors related to unreconciled medications. Organizations that are considering creating a medication reconciliation process can use this tool to establish a baseline measure of errors from unreconciled medications and to build a case for the importance of having a reconciliation process in place.


Reconciliation is a process of identifying the most accurate list of all medications a patient is taking — including name, dosage, frequency, and route — and using this list to provide correct medications for patients anywhere within the health care system. Reconciliation involves comparing the patient’s current list of medications against the physician’s admission, transfer, and/or discharge orders. Experience from hundreds of organizations has shown that poor communication of medical information at transition points is responsible for as many as 50 percent of all medication errors and up to 20 percent of adverse drug events in the hospital.


Each time a patient moves from one setting to another, clinicians should review previous medication orders alongside new orders and plans for care, and reconcile any differences. If this process does not occur in a standardized manner designed to ensure complete reconciliation, medication errors may lead to adverse events and harm.



Hospitals have used this tool to identify unreconciled medications by comparing medication orders at the time of admission with the medication history provided by the patient or family, and by comparing discharge medication orders to the medications administered during the hospital stay and the medication history prior to admission. This review process has helped organizations establish a baseline of errors from unreconciled medications and build a case for the importance of having a reconciliation process in place.



To use this tool most effectively, an organization should first identify a multidisciplinary team consisting of, at a minimum, a nurse, a pharmacist, and a physician. Obtain a set of closed patient records, using a selection process that is as random as possible, and review the patient records for errors due to unreconciled medications.


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