Medication Reconciliation

February 2026 · 4 min

Overview

Medication Reconciliation is a safety process that compares the medications a patient was taking before admission (home medications) with medications ordered during the hospital stay, and ensures an accurate, complete medication list at each transition of care -- admission, transfer, and discharge. This reduces medication errors caused by unintentional omissions, duplications, or interactions.

Reconciliation Phases

The reconciliation process runs at three key transitions:

1. Admission -- Home medications are documented and compared with newly ordered inpatient medications. Discrepancies (omissions, dose changes, new additions) are flagged for physician review.
2. Transfer -- When a patient moves between units (e.g., ICU to general ward), medications are reconciled to ensure the correct regimen continues.
3. Discharge -- The discharge medication list is compared with the inpatient regimen and home medications to produce a complete, accurate discharge prescription.

Each phase generates a reconciliation record with the source medications, target medications, and decisions made for each drug.

Decision Options

For each medication during reconciliation, the clinician can select:

• Continue -- Medication continues at the same dose and route
• Modify -- Dose, route, or frequency is changed (requires documentation of reason)
• Discontinue -- Medication is stopped (requires documentation of reason)
• Add -- A new medication is being added that wasn't on the source list
• Hold -- Temporarily suspended (e.g., NPO for surgery)

All decisions are timestamped, attributed to the clinician, and stored in the medication_reconciliations table for audit purposes.

Safety Alerts

During reconciliation, the system provides:

• Drug-drug interaction alerts between continued and new medications
• Allergy cross-checks against the patient's documented allergies
• Therapeutic duplication detection (two drugs from the same class)
• High-alert medication flags (insulin, anticoagulants, opioids, etc.)
• Renal/hepatic dose adjustment reminders based on lab values

Integration

Medication Reconciliation integrates with:

• IPD Admission Detail -- Reconciliation panel available for every admitted patient
• eMAR -- Reconciled medication list feeds directly into the eMAR schedule
• Discharge Planning -- Discharge reconciliation auto-populates the discharge prescription
• Patient Portal -- Patients receive a clear medication list at discharge via the portal
• Pharmacy -- Pharmacist review queue for all reconciliation changes

Notes

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