Which of the following is the best and most complete definition of medication reconciliation? An In-Depth Explanation

October 11, 2025 •

3 min read

Medication discrepancies at hospital admission occur in up to 50% of patients, with potential for significant harm. Understanding which of the following is the best and most complete definition of medication reconciliation is crucial for healthcare providers aiming to enhance patient safety and ensure continuity of care.

Quick Summary

A comprehensive guide to medication reconciliation, detailing the best definition, the step-by-step process of creating the most accurate medication list, comparing orders, and resolving discrepancies at care transitions.

Key Points

Complete Definition: A formal, collaborative process to identify the most accurate list of a patient's medications and compare it to new orders at every transition of care.
Preventing Errors: The primary purpose of medication reconciliation is to prevent medication errors like omissions, duplications, dosing mistakes, and drug interactions.
All-Inclusive List: The process must include all medications—prescription, over-the-counter, supplements, and vitamins—to create a Best Possible Medication History (BPMH).
Transitions of Care: Reconciliation is essential at transitions, such as hospital admission, transfer between units, and discharge, to ensure continuity and safety.
Multi-Step Process: The workflow involves verifying the medication history, clarifying its appropriateness, reconciling discrepancies with new orders, and transmitting the updated list.
Team Effort: Effective reconciliation requires collaboration among healthcare professionals like physicians, nurses, and pharmacists, as well as patient and caregiver involvement.
Distinct from Review: Medication reconciliation is a foundational step focused on accuracy, whereas a medication review is a broader evaluation of the overall therapy's appropriateness.

The Best and Most Complete Definition of Medication Reconciliation

The most comprehensive definition of medication reconciliation is a formal process designed to prevent medication errors during care transitions. This involves creating the most accurate list of a patient's medications, known as the Best Possible Medication History (BPMH), which includes all types of medications like prescriptions, over-the-counter drugs, herbal products, vitamins, and vaccines, noting their dosages, frequencies, and routes. This BPMH is then compared with new medication orders in the new care setting, and any differences, or discrepancies, are documented and resolved by the healthcare team. The final reconciled list and plan are then communicated to the patient, caregivers, and other providers. This process is particularly important at points like hospital admission, transfer between units, or discharge, with the goal of reducing errors, adverse drug events, and preventable hospital readmissions.

The Step-by-Step Medication Reconciliation Process

A structured four-step approach is commonly used in medication reconciliation:

Verify: Gather a complete and accurate medication history, often by talking to the patient and family, and checking sources like pharmacies or old records.
Clarify: Review the gathered information to ensure medications and dosages are appropriate for the patient's current condition.
Reconcile: Compare the new medication orders against the verified history, resolve discrepancies through clinical judgment, and document the final list.
Transmit: Share the accurate, final medication list with all relevant parties, including providing a clear list to the patient upon discharge and sending updated information to their next provider.

The Crucial Role of Medication Reconciliation in Patient Safety

Medication reconciliation is fundamental to patient safety:

Error Reduction: It effectively lowers medication error rates, which are frequent during transitions of care, preventing issues like missed medications or incorrect doses.
Improved Outcomes: By preventing errors, it helps decrease hospital readmissions and adverse drug events. Pharmacist-led reconciliation, for example, has been linked to fewer readmissions.
Enhanced Communication: The process promotes clear communication within the healthcare team and with the patient.
Support for Adherence: Reviewing medications with the patient provides an opportunity to discuss adherence and educate on proper usage.

Comparison: Medication Reconciliation vs. Medication Review

Medication reconciliation and medication review are distinct but related processes.


Feature	Medication Reconciliation	Medication Review
Primary Purpose	Ensure medication list accuracy and prevent errors during transitions of care.	Critically evaluate the appropriateness, effectiveness, and patient-centeredness of a patient's overall medication therapy.
Timing	Performed at every transition of care (e.g., admission, transfer, discharge).	Conducted regularly as part of routine care, or when a patient's condition changes.
Focus	Comparing two lists (BPMH vs. new orders) and resolving discrepancies.	Evaluating the entire medication regimen against patient needs, goals, and conditions.
Example Action	Noticing an antidepressant was not re-ordered post-admission and flagging it for a physician to address.	A pharmacist discussing potential side effects, adherence issues, and treatment goals with a patient.
Pre-requisite	Can be a prerequisite for a thorough medication review, as an accurate list is foundational.	Requires a foundational, accurate medication list (established via reconciliation) to be effective.

Overcoming Challenges to Effective Reconciliation

Challenges to effective medication reconciliation include inaccurate patient information, fragmented health information systems, time constraints for clinicians, and potential communication breakdowns. Solutions involve getting information from multiple sources like family and pharmacies, using health information exchanges, assigning dedicated staff for medication history, and implementing standardized communication methods.

Conclusion: A High-Stakes Patient Safety Practice

Medication reconciliation is a formal, collaborative process where healthcare providers, patients, and families work together to create the most precise list of medications at each change in care setting. This practice is essential for reducing hospital readmissions and adverse events and improving patient adherence, making rigorous medication reconciliation a fundamental element of safe, high-quality patient care.

Medication Reconciliation Handbook - Agency for Healthcare Research and Quality

Frequently Asked Questions

The primary purpose of medication reconciliation is to identify and resolve discrepancies in a patient's medication regimen at every transition of care. This helps to prevent medication errors such as omissions, duplications, and dosing mistakes that can lead to adverse drug events.

Medication reconciliation should be performed at every transition of care, including hospital admission, transfer between hospital units, and hospital discharge. It should also be completed in other care settings like outpatient clinics or long-term care facilities when a patient's medication list is updated.

A Best Possible Medication History (BPMH) is the most accurate and comprehensive list of a patient's current medications. It includes all prescription medications, over-the-counter drugs, herbal supplements, vitamins, and other non-prescribed remedies.

Medication reconciliation is a collaborative effort involving the entire healthcare team. While trained personnel like pharmacists or pharmacy technicians may obtain the medication history, ultimate reconciliation is typically overseen by a physician or other licensed prescribing practitioner.

The key steps are: 1) Verify the medication history, 2) Clarify that the medications and dosages are appropriate, 3) Reconcile any discrepancies with new orders, and 4) Transmit the updated list to all involved parties.

Medication reconciliation focuses on ensuring the accuracy of the medication list at care transitions, comparing lists to find discrepancies. A medication review is a broader, critical evaluation of the entire medication regimen to assess its clinical appropriateness and patient-centeredness.

Electronic health records (EHRs) can help by consolidating medication histories, providing automated alerts for potential interactions, and standardizing documentation. However, technology still needs to be complemented by thorough patient interviews, as EHRs may not capture all OTCs or supplements.