A Practical Approach to Medication Reconciliation by Pharmacists in a Community Hospital Emergency Department

Purpose The purpose of this paper is to describe the process of medication reconciliation by an emergency department (ED) pharmacist. Summary The ED pharmacist has many opportunities to interact with patients. Medication reconciliation by a pharmacist helps ensure a complete and accurate list of medications is obtained and documented. The process can be broken down into 3 categories—database, validation, and documentation. The database and validation steps involve gathering and confirming information related to medications patients are taking. These are the most challenging and time-consuming steps. The database step involves gathering current and previous information about the patient and using clinical skills to ensure a patient's medical problems are adequately treated. Many times patients do not know their medications well enough to provide the necessary information. To overcome this barrier, calls to pharmacies, physician offices, and other health care facilities may be necessary. At times, the use of electronic drug information databases to show patients images of medications is necessary for validation. Standard questions have been developed that probe patients on medications commonly left off of medication lists. The documentation step completes the process because it demonstrates a complete and accurate medication list for the patient's next health care provider. Conclusion The process of medication reconciliation is more than a translation of a medication list. Clinical skills are often necessary to ensure medication reconciliation is performed accurately and completely. Following the process of database, validation, and documentation helps ensure optimal pharmaceutical care.