Medication history and reconciliation

Medication Reconciliation is a process where we will gather a complete and accurate list of all the medications you were taking at home. We then compare this list to what your doctor has prescribed for you when you are admitted, transferred or discharged from the hospital. We do this because studies have shown that patients are at a higher risk of medication errors at these times. When we do our medication reconciliation, if we notice any differences we will document them and bring them to the attention of your healthcare team to be resolved. This process has proven to improve patient safety, as well as save money for the healthcare system.  

A number of your care team members will take part in this medication reconciliation process including doctors, medical residents and medical students, nurses, nurse practitioners, pharmacists, pharmacy technicians and pharmacy students.

To begin this process, we first must work with you to gather the best possible medication history. This includes name of each drug you take, how much you take, how often you take them and how you take them (by mouth, injected, in your eyes, etc.) This process should include prescription medications, over-the-counter medications, vitamins, minerals and natural health products. If possible, please bring all of your medications to the hospital with you to help with this process, you are the most important person to help us learn about your medications. 

Other ways we gather this information include the Ontario Drug Benefit Medication Claims List, Community Pharmacy Medication List, Medication Administration Record if you live at a Nursing Home, medication vials, blister packs, and by speaking to your family doctor. 

With the team, we go over each of your home medications and decide which ones are appropriate to continue, stop, or change while you are in hospital.  When you are ready to be discharged from the hospital, we will go over the list again and compare it to what you were taking in the hospital and let you know what is still the same, what has changed, if anything is new or was stopped.