Do / medication safety
Medication reconciliation: keeping a care transition clear
When care moves between teams or settings, medicine information needs to move with it. Medication reconciliation checks what a person was using against new orders and makes differences explicit. It is more than copying a list.
A transition changes who holds the information
Admission, transfer and discharge can bring a new team, a new record and changes to medicines. Information can be lost between these steps. WHO treats transitions of care as a priority for medication safety, including moves between home, hospital and other care settings. A change in a medicine is not automatically a mistake: it may be an intended clinical decision. The task is to distinguish that decision from an unintended discrepancy and communicate it clearly.
Evidence: WHO: Medication safety in transitions of care (2019)
Build a history, then check it
Reconciliation begins with an accurate history of what the person was using, not just the first list found in a record. AHRQ includes prescription medicines, over-the-counter products, vitamins, supplements and other preparations such as eye drops and creams. WHO describes combining a patient interview with another reliable information source. A list copied from an earlier encounter may be a lead, but the team still needs to verify whether it describes current use.
Evidence: WHO: Medication safety in transitions of care (2019) / AHRQ MATCH toolkit: Introduction
A discrepancy needs a clinical explanation
The team compares the history with medicines ordered at admission, transfer or discharge. Differences can include an omitted medicine or a changed dose or frequency. Some differences are deliberate; others need clarification with the prescriber. AHRQ emphasizes documenting and resolving unintended discrepancies. Reconciliation is not permission to restart every old medicine. Medication review, which considers whether treatment remains appropriate for a person, is related but is not the same task as checking and communicating the list.
Evidence: WHO: Medication safety in transitions of care (2019) / AHRQ MATCH toolkit: Introduction / AHRQ MATCH toolkit: Education and training
Give each step a clear owner
A team process needs defined responsibilities for collecting the history, verifying it, comparing orders, clarifying differences and communicating the result. AHRQ recommends a shared medication list available to the disciplines caring for the patient, with updates visible as better information arrives. Paper and electronic systems can both support this work. An electronic record does not remove the need for verification, clear decisions and a workflow that people can follow.
Evidence: AHRQ MATCH toolkit: Designing the reconciliation process
Discharge is a handoff, not just a printout
An updated list needs to explain the medicines to be used after discharge and the changes made during care. WHO emphasizes communicating changes to patients and future care providers; AHRQ describes explaining new, changed and discontinued medicines. Patients, families and caregivers can help clarify actual use and raise questions, but the institution remains responsible for its process. A list that nobody understands or receives is not the same as a completed handoff.
Evidence: WHO: Medication safety in transitions of care (2019) / AHRQ MATCH toolkit: Introduction / AHRQ MATCH toolkit: Education and training
Use the guide within its limits
This is a general account of medication-information safety, not a dosing protocol, a local hospital policy or a Mynd clinical service. A person reading it should not start, stop or change a medicine on the basis of this page. Questions about conflicting instructions need the treating clinician or pharmacist. The sources describe system design and professional work; implementing a process also requires local clinical responsibilities, training and applicable requirements.
Evidence: AHRQ MATCH toolkit: Designing the reconciliation process / AHRQ MATCH toolkit: Education and training
Source note
This is general health-science education. No clinical review has been performed.
General education, not a dosing protocol, adopted hospital policy, clinical service or advice to change medicines.