Table of Contents

• Table of Contents
• Introduction
• Learning Objectives
• What is Medication Reconciliation?
• What is the Impact of Medication Reconciliation?
• Who Should be Involved in Medication Reconciliation?
• How to Obtain the Best Possible Medication History (BPMH)
• How to Identify and Reconcile Discrepancies
• Medication Reconciliation at Transfer
• Medication Reconciliation at Discharge
• Final Summary
• Appendices
  • Appendix 1: Patient’s Guide to Medication Reconciliation, University Hospital Network
  • Appendix 2: Best Possible Medication History Interview Guide
  • Appendix 3: Sample BPMH Form
  • Appendix 4: Sample BPMH Form from Kingston General Hospital
  • Appendix 5: Sample BPMH and Admission Order Form, Capital Health, Nova Scotia
  • Appendix 6: Example of a Prescription Showing the Best Possible Discharge Plan
  • Appendix 7: Example of Letter to Community Pharmacist Showing BPMDP
  • Appendix 8: Example of a Medication Chart for the Patient Showing the Best Possible Discharge Plan
• References