Proportion of patients for whom medication reconciliation was completed at discharge

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Proportion of patients for whom medication reconciliation was completed at discharge

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Admission into the hospital can result in a patient receiving new medications or having changes made to their existing medications. Medication reconciliation is a systematic and comprehensive review of all the medications a patient is taking, including prescription and non-prescription drugs, to ensure that medications being added, changed or discontinued are carefully evaluated and communicated consistently across transitions of care.

Click here to visit Ontario Health’s Indicator Library to view how to measure medication reconciliation at discharge.

Key resources:

Change Ideas

Conduct medication reconciliation within 24-48 hours of being admitted to hospital

Conduct medication reconciliation within 24-48 hours of being admitted to hospital
Medication Reconciliation in Acute Care: Getting Started Kit by CPSI and ISMP Canada
Support patients and caregivers to keep track of their medicines with appropriate tools
MyMedRec by ISMP Canada
MedsCheck
A Quick Guide to Medication Reconciliation for Patients by UHN
Ontario Health Quality Standard Medication Safety

Define the roles interdisciplinary providers play in medication reconciliation

Define the role of the physician in an interdisciplinary approach to medication reconciliation
The Physician’s Role in Medication Reconciliation: Issues, Strategies, and Safety Principals by the American Medical Association
Define the roles of the pharmacist and pharmacy technician in an interdisciplinary approach to medication reconciliation
“Always Use Teach-back”: Training by UnityPoint Health, Health Literacy Iowa, and Des Moines University
Provide training to providers responsible for collecting best possible medication history
ISMP Canada Medication Reconciliation

Ensure hospital infrastructure supports the process of medication reconciliation

Engage senior leadership
Ontario Health Quality Standard Medication Safety
Use technology to support key processes
Paper to Electronic MedRec Implementation Toolkit 2nd Edition

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