Medication Reconciliation at Transfer

Transfer is an interface of care associated with a change in the patient’s status and may include:

• change in responsible medical service or level of care
• post-operative transfer
• transfer between units

The goal of medication reconciliation at transfer is to ensure all medications are appropriate for the patient’s new status of care. The process involves assessing and accounting for:

• medications the patient is taking prior to admission (BPMH)
• medications the patient has received since admission (MAR - Medication Administration Record)
• new post-transfer medication orders (includes new, discontinued and changed medications upon transfer).

The team makes decisions about the appropriateness of continuing existing hospital medications, as well as assessing the need to resume or discontinue pre-admission medications.

Medication reconciliation at transfer ensures that changes are intentional and discrepancies are identified and resolved. This should result in avoidance of therapeutic duplications, omissions, unnecessary medications and confusion.

Medication Reconciliation at Transfer Model

BPMTL: Best Possible Medication Transfer List