How to Identify and Reconcile Discrepancies
Differences (discrepancies) between AMOs and the BPMH can be divided into three main categories: documented intentional, undocumented intentional or unintentional.
Documented Intentional discrepancy: prescriber intentionally adds, changes or discontinues a medication and this is clearly documented. This is considered the ‘best practice’ in medication reconciliation.
Example: a patient is admitted with pneumonia and started on an antibiotic which they were not on at home. This is clearly documented on the chart and is an intentional discrepancy.
Undocumented intentional discrepancy: prescriber intentionally adds, changes or discontinues a medication but this is not clearly documented in the patient’s medical record.
Unintentional discrepancy: prescriber unintentionally changes or omits a medication the patient was taking prior to admission.
In order to determine whether a discrepancy is unintentional or an undocumented intentional, the information should be clarified with the prescriber. The clarification can be done in person, by email/fax or phone. If the discrepancy was intentional, then the proper documentation is required on the chart. If the discrepancy is unintentional, then the prescriber can resolve the discrepancy by writing a new order.
The following diagram illustrates the medication reconciliation process.
Identifying and Resolving Discrepancies in Medication Reconciliation8
Medication Reconciliation Process Flow Map: Admission to Healthcare Facility
