What is Medication Reconciliation?

What the clinical process covers

AHRQ's PSNet primer on medication reconciliation describes reviewing the medication regimen at admission, transfer and discharge against the regimen intended for the new setting. Differences can be intentional or accidental. Identifying and resolving discrepancies is part of the care team's work, not just copying a list.

A three-column way to prepare questions

Our worksheet organizes the records into taken at home, given during the stay, and prescribed at discharge. This is a practical organizing format, not a required clinical protocol. Mark apparent changes as New, Stopped, Dose or timing changed, or Unchanged; add “needs confirmation” whenever the instructions are unclear.

For an illustrative comparison of eleven medicines, you might count two new, two stopped and one with changed instructions. That count prepares five questions; it does not establish whether any of those changes are correct. Ask the prescriber or pharmacist to confirm the current plan before acting on a discrepancy.

Why the family's own list matters at admission

A current home list gives the care team a starting point when the patient cannot recall every medicine. Check it with the person taking the medicines and include any uncertainty about actual use. Treat the family copy as information to verify with the care team, not as an independent prescription.

The family's record supports clinical review

A family can record names, actual use and questions; clinical reconciliation goes further by resolving discrepancies. AHRQ's brown-bag review guidance recommends bringing medicine containers and discussing how they are actually used with the reviewing clinician, pharmacist or nurse. Include over-the-counter medicines and supplements as well as prescriptions.

Medication reconciliation vs a medication tracker

A medication tracker is an ongoing record: the medicines someone takes day to day, their doses, and their refill schedule, kept up over months. Medication reconciliation is tied to a transition — it includes the clinical review done around a hospital stay, at the points where the list is most likely to change without anyone noticing. A well-kept tracker helps prepare the "what was taken at home" column for confirmation; the two support each other rather than replacing one another.

More on a hospital stay

Reconciliation is one piece of a discharge. The discharge summary is the clinical record the hospital writes about the whole stay, and its medicine list is meant to be the reconciled one; what to ask before a hospital discharge covers the medicines alongside the five other domains a discharge turns on; and a printable kit versus the patient portal discusses how a personal record can complement the hospital portal.

Where to start

Begin with the free One-Page Patient Summary — no email, no signup. It's the single sheet that records the home medicine list, conditions, and allergies to hand a new clinician on arrival.

The Hospital Stay & Discharge Field Kit is built around the comparison itself: a working sheet that takes those three lists and writes New, Stopped, Dose changed, or Unchanged against every medicine, counts the result, and writes the hand-over page from the same numbers — a fillable PDF, print-and-carry, no spreadsheet involved. The caregiver templates hub has the rest of the set.

This is a records-organizing approach — not medical advice, and not a substitute for the prescriber or pharmacist going through the list with you.