Medication reconc­ili­ation is the process of creating the most accurate list possible of all medica­tions a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physic­ian’s admission, transfer, and/or discharge orders, with the goal of providing correct medica­tions to the patient at all transition points within the hospital or nursing home.

1. Medication reconc­ili­ation is a necessary component of safe medication manage­ment. The process is ongoing and dynamic.
2. The medication reconc­ili­ation process should be patien­t-c­ent­ered.
3. Shared accoun­tab­ility between health care profes­sionals and patients is essential to successful medication reconc­ili­ation outcomes.
4. All patients should have an accurate medication list for use across sites of care and overtime.
5. The medication list should not be limited to prescr­iption drugs.
6. Within all settings, the medication reconc­ili­ation process should happen at every medication encounter, regardless of the care location.
7. Across all settings, the medication reconc­ili­ation process must happen at every transition in the patient's care, regardless of the care transi­tion.
8. The process of medication reconc­ili­ation is interd­isc­ipl­inary and interd­epe­nde­nt—and reliant on a team approach.
9. Physicians are ultimately respon­sible both ethically and legally for the medication reconc­ili­ation process.
10. Some medication inform­ation may be emotio­nally or legally charged, but nevert­heless signif­icant. It may be added at the discretion of the patient or prescr­ibing health care profes­sional by mutual decision.

1. Collection of an Accurate list of medica­tions that the patient is actually taking
2. Making sure the medica­tions and dosages are approp­riate for the patient's comorb­idities
3. Educating the patient about the medica­tions
4 Docume­nting each step of reconc­ili­ation

1. Assembling the lists of medica­tions.
2. Ascert­aining accuracy (review and compare prior and new lists)
3. Reconc­iling medica­tions and resolving discre­pancies
4. Formul­ating a decision, i.e., making a medical judgment with respect to the patient’ s condition and medica­tions.
5. Optimizing care to best meet the patient's needs with this inform­ation
6. Checking the patient's (and/or careta­ker’s) unders­tanding of their medica­tions.
7. Docume­nting changes and providing the patient with a copy of his or her current medication list.