Who Should be Involved in Medication Reconciliation?

The medication reconciliation process is a shared responsibility of healthcare providers in collaboration with patients and families. It requires a team approach including nurses, pharmacists, physicians and other healthcare providers. It requires some additional training for key clinicians involved. The actual roles and responsibilities for each discipline and clinician are based on the team’s optimal medication reconciliation practice model which takes into account available staffing resources. Effective models differ from hospital to hospital and within a hospital from team to team.

Patients and families are the central resource to communicate their own personal medication taking practices and assist by providing medication vials and lists.7 It is very important that patients and their families understand the purpose of their medications and how to take them. The following resources provide useful tips about how to use your medications:

The pharmacist’s role in medication reconciliation is to coordinate the process. The pharmacist, wherever possible, should take primary responsibility for ensuring proper communication of medication information to patients and other healthcare providers on admission, transfer and discharge. The pharmacist also ensures that medications are selected and ordered appropriately based on the patient’s clinical condition and other factors.

The physician’s role in medication reconciliation is to ensure that the patient’s medication orders on admission, transfer and discharge are completed as completely and accurately as possible. Any changes to medications should be documented in the chart and any discrepancies resolved as soon as possible. The American Medical Association has recently published an on-line medication reconciliation education program for physicians (available at: http://www.ama-assn.org/ama/no-index/ physician-resources/medication-reconciliation.shtml.

The nurse’s role in the medication reconciliation process is essential because she must have a good understanding of all the medications a patient is to receive and why. Also, certain medications that the patient was using at home may not be supplied by the pharmacy because they are on the hospital formulary. This requires communication between the pharmacist and the nurse to ensure that any “patient’s own” medications are identified, stored and administered safely. The College of Nurses of Ontario Medication Practice Standard (2008) includes medication reconciliation (available at: http://www.cno.org/docs/prac/41007_Medication.pdf.


This excercise is also available as a PDF.

Describe your role in medication management on your team. Are you responsible for:

  • Prescribing?
  • Medication history-taking?
  • Identification and clarification of medication order discrepancies?
  • Communication of medication information on transfer or discharge?
  • Documentation of medication order discrepancies?
  • Education of patients and families about medications?
  • Follow up communication with other health care providers after discharge?