1. Hale, Deborah MSN, RN, ACNS-BC
  2. Marshall, Katherine DNP, PMHCNS-BC, NP, CNE

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Medication reconciliation is a critical aspect of overall patient safety. Due to polypharmacy, older adults are often at high risk of medication errors (Dionisi et al., 2022) with some type of medication reconciliation discrepancy occurring in 94% of older adults (Taylor, 2021). Medication errors have significant impact on patients' lives, causing reduced quality of life, greater risk for falls and injuries, and an increased risk of hospitalization (Dionisi et al., 2022). Home healthcare clinicians need to recognize errors in the medication process and report them accordingly. Thus, regular training and quality management is crucial for the safest medication process possible. Common errors include taking the wrong dose or quantity of a particular drug, omission of a drug, or taking unlicensed drugs. Medication errors can be a result of poor communication among physicians, home health staff, and other parties; poor documentation; or transferring information from multiple lists (Dionisi et al., 2022).


The medication reconciliation process is a way to prevent medication errors. According to Taylor (2021), here are some tips for a comprehensive medication reconciliation:


* Ask the patient to have all medications available for the home care visit (including over-the-counter drugs, herbs, supplements, creams, inhalers, and as-needed medications).


* Assess the patient's understanding of their medications and gather information from additional resources (hospital discharge papers, assisted living facility records, provider records, and the patient's pharmacy), and compare each prescription bottle to the medication list in the provider record.


* Look for high-risk medications such as opioids, hypoglycemics, antipsychotics, and anticoagulants and assess for duplication.


* Ask the patient if they are taking the medication as prescribed or what barriers are preventing proper medication administration.


* Assess how the patient dispenses the medication and help them find an agreeable method to follow.


* Ask the patient about each medication's indication and assess their response.


* Discuss risks, benefits, and side effects of each medication.


* Instruct on safe disposal of unnecessary medications.


* Assess the patient's willingness to take the medication, its affordability, and whether it is realistic for the patient to adhere to the medication schedule.


* Assess the patient's ambulatory status and dexterity to determine if occupational and/or physical therapy disciplines need to be added to the plan of care.



Clinicians should utilize teach-back and communicate at the patient's health literacy level while ensuring sensory deficits, such as hearing and/or eyesight, are addressed. Make sure hearing aids are in place, reduce background noise, and write out instructions. For those with limited vision, ensure adequate lighting, have a magnifying glass available, or request help from family or caregiver. Patients with cognitive impairments also need additional support, and some options to ensure their safety by using 7-day pill containers or utilizing technology-assisted reminders. These processes can improve outcomes and overall quality of life for the patient.




Dionisi S., Di Simone E., Liquori G., De Leo A., Di Muzio M., Giannetta N. (2022). Medication errors' causes analysis in home care setting: A systematic review. Public Health Nursing, 39(4), 876-897. [Context Link]


Taylor K. (2021). Geriatric medication reconciliation in the home setting: A patient-centered approach can improve outcomes. American Nurse Journal, 16(7), 14-18. [Context Link]