Medication reconciliation, in some form or another, is now standard of care in most hospitals and an expectation of The Joint Commission and Accreditation Canada. In their systematic review of hospital-based medication reconciliation practices, Mueller et al1 offer a useful reminder of the literature supporting this widespread adoption and suggest some future challenges.
Similar to many contemporary innovations in practice, medication reconciliation is not a single act or intervention. Instead, it involves a “bundle” of related critical elements applied during the high-risk period of hospitalization. Hospitals are grappling with some essential questions: What strategies for medication reconciliation are most effective? Which patients will benefit most? Is admission or discharge reconciliation most essential? Which health care professionals should lead and contribute?2 This review illustrates that medication reconciliation is not a single intervention but rather takes place at various transitions (ie, admission, transfer, and discharge), involves a range of pharmacy expertise (ie, pharmacy technicians to clinical pharmacists), and may variously include all patients or target patients at high risk for adverse clinical outcomes (eg, adverse drug events and rehospitalizations).