Medication reconciliation is a collaborative effort between patients, care-givers and prescribers that lists all medications (prescription and over the counter) and supplements such as vitamins. The list should include both the trade and generic names of medications as well as the doses and the time of day taken. Drug allergies should be noted. This reconciliation will guide prescribing decisions and will help prevent medication errors that could harm patients.
Older patients are at higher risk for medication errors since they may have several medical problems for which they see several physicians. The same medication may be ordered twice: once by the trade name and again as the generic. The medical reconciliation should also ensure that the patient is actually taking the medication (and if not, why not).
Adverse medication events include physical harm, mental harm or loss of function. The clinician should review the medication list at each visit and adjust medications as needed. All effort should be made to avoid high-risk drugs, unnecessary drugs, and drugs causing side effects. Computer programs are helpful in detecting potential drug-drug interactions and provide dosing guidelines if there is impaired kidney or liver function. The e-prescribing programs as also helpful but can be too inclusive: a potential drug-drug alert will pop up for an antibiotic that was used once three years prior.
Patients must take an active role in keeping their medication lists up to date. When in doubt, brown bag every medication bottle and bring it along to every doctor’s visit. Keep a list of medications in your wallet along with the list of allergies.
One study found that medication errors were responsible for 1.4 percent of hospital admissions, of which 28 percent were preventable. The FDA is developing systems to minimize errors. An excellent brochure (PDF) has recommendations and safety tips for patients.