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Clinical Practice Guidelines
Medication Management and Reconciliation
The following outlines steps in the medication management cycle and related Clinical Decision Support (CDS)
opportunities.
Medication Selection/Reconciliation (prescriber, nurse, pharmacist)
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Select for a clinical condition, a medication that is safe and effective, appropriate for a specific patient and
circumstance, and available within an organizational formulary. The selection should be based on clinical
evidence, best practice, patient characteristics, and cost-effectiveness. The selection process requires access to
pertinent patient information (such as clinical history, weight, height and age) as well as pertinent disease
management knowledge (for example, evidence-based best practice treatment approaches: and drug
information addressing dosing, side effects, costs, interactions, contraindications)
Support medication reconciliation with an accurate list of the patient’s medications, along with medication
identification and therapeutic use information.
Provider Ordering (prescriber)
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Reconciles current medications, dose, frequency and administration schedule at every patient visit.
Write prescription (ideally linked to the medical indication) for the patient to take.
Dose prescription specifically for the patient and clinical condition
Communicate reference information, when appropriate, for contraindications, duplications, drug-drug
interactions, drug-lab interactions, clinically significant allergies, right dose/route/frequency.
Determine and schedule follow-up interval to evaluate patient response to medication.
Verification/Dispensing (pharmacist, pharmacy staff)
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Double check for interactions, appropriateness/contraindications, right dose/route/frequency/timing.
Match prescription to correct dose and dose form.
Administration (patient or caretaker, nurse)
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Make positive medication and patient identification
Assess patient and document pertinent parameters such as (blood pressure, heart rate, blood glucose, pain
level) prior to administration.
Check for incompatibilities/interactions, such as between medications and foods, etc.
Recheck right dose/route/frequency, administration technique and timing, monitoring guidelines
Provide reminder/guidance when medications are not administered at the appropriate time or are delayed or
missed.
Follow up with provider as scheduled to monitor patient response.
Clinical Practice Guidelines
Medication Management and Reconciliation
Education (patient or caretaker, pharmacist, nurse, prescriber, other clinicians)
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Engage patient in effective medication use,
help patient understand how and why to properly take medications (including indication,
administration and desired effects),
Educate patient/caregivers on how to appropriately store and handle medications, and
Ensure patient/caregiver are aware of potential adverse effects to be vigilant for and how to address
them;
Ensure patient understanding of information (whether communicated via discussion, handouts,
audio/video materials and other media.
Engage caregiver/parent when needed to support patient.
Monitoring (patient or caregiver, nurse, other clinicians, pharmacist, prescriber, health system)
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Verify proper patient adherence to the medication regimen
Anticipate and monitor individual desired and adverse effects, (for example, through
history/symptoms, examination, and check of appropriate labs with notification of critical labs/adverse
effects.
Track adverse events across populations, for example (ideally) via robust structured data-reporting
system that incorporates medication error taxonomy standards, and updating the patient record with
any new allergy/side effect/interaction.
Provide feedback and input about patient medication use – across care settings – into the medication
reconciliation/selection step, and thus help close the medication management loop.
All individuals and components of the medication management cycle are connected. It is imperative to
remember these connections going forward to avoid the tendency to isolate key tasks in silos. Well
executed clinical decisions support knowledge and data flows help optimize care quality and efficiency.
References:
Applying Clinical Decision Support to Medication Management
http://healthit.ahrq.gov/ahrq-funded-projects/clinical-decision-support-initiative
Clinical Practice Guidelines
Medication Management and Reconciliation
Legal Disclaimer: Clinical Practice Guidelines made available by Family Health Network are informational in nature and are not a
substitute for the professional medical judgment of treating physicians or other health care practitioners. These guidelines are
based on information available at the time and may not be updated with the most current information available at subsequent
times. Individuals should consult with their physician(s) regarding the appropriateness of care or treatment options to meet their
specific needs or medical condition. Disclosure of clinical practice guidelines is not a guarantee of coverage. Members of Family
Health Network health plans should consult their individual coverage documents for information regarding covered benefits. Family
Health Network does not offer medical advice or provide medical care, and therefore cannot guarantee any results or
outcomes. Family Health Network does not warrant or guarantee, and shall not be liable for any deficiencies in the information
contained herein or for any inaccuracies or recommendations made by independent third parties from whom any of the information
contained herein was obtained.
Approved: Professional Peer Review Committee 2/19/2015