In “The physician’s role in medication reconciliation,” the panel aims to heighten physician awareness of the integral role of reconciliation in the safe use of medications and to provide a framework for physicians to understand their personal roles and responsibilities in this often difficult process of care.
The essence of medication reconciliation is making sense of a patient’s medications and resolving conflicts between different sources of information to minimize harm and to maximize therapeutic effects. It is an ongoing, dynamic, episodic and team-based process that should be led by and is the responsibility of the patient’s attending or personal physician in collaboration with other health care professionals. Medication reconciliation is essential to optimize the safe and effective use of medications.
After completing this activity, participants should be able to:
- Describe medication reconciliation principles and processes
- Distinguish the physician's role in the medication reconciliation process
- Integrate patient-centric aspects of medication reconciliation into practice
- Create a medication management plan with your patients
- Integrate principles and processes into practice in all settings of care
- Identify appropriate medication reconciliation team in all settings of care
- Identify proper delegation of clinical and nonclinical medication reconciliation responsibilities
- Lead your organization's efforts to support medication reconciliation
This monograph first provides background on medication issues, including: medication errors and adverse drug events, communication problems and medication reconciliation’s relationship to patient safety. It then presents an overview, including the steps of medication reconciliation, the underlying principles of medication reconciliation for deeper understanding of the physician’s leadership role and obligations, and guidance for effective achievement of medication reconciliation. This is followed by strategies for two particularly important areas of medication reconciliation: taking a medication history and promoting patient understanding of their medication regimen. Case study examples illustrate medication reconciliation failures and can be the basis for discussions physicians may have with their medical team and with their patients.
Recognizing that ultimately all health care safety and factors affecting medication reconciliation must be customized to the particular patient and practicing setting, this monograph does not offer rigid prescriptions, but rather general principles that physicians and their teams may adapt to their specific circumstances and needs. Because medication reconciliation represents an integral part of the patient safety effort, this monograph offers guidelines and information on developing support for medication reconciliation in the context of core safety principles. It provides useful information for physicians’ use in local improvement efforts and in advocacy for medication safety.
Finally, this monograph discusses important special topics critical to effective medication reconciliation: information technology, coordination of care and vulnerable populations. Information technology has tremendous potential, but it also poses significant challenges. This discussion highlights some of those issues. It also reviews a key issue in medication reconciliation—coordination of care—and sketches a directly related effort to address this concern (i.e., medical homes). In addition to enhancing coordination of care, medical homes may provide important benefits to older and minority populations—groups that are disproportionately affected by ineffective medication reconciliation. Lastly and significantly, the monograph discusses vulnerable patient populations, including older adults and minorities, and provides examples and potential strategies to improve medication reconciliation for these patients.
For information on receiving CME credit, go to http://www.ama-assn.org/ama/no-index/physician-resources/medication-reconciliation.shtml.