Medication Reconciliation Step by step Guide

Follow these simple steps to complete a Medication Reconciliation. Whether it's your first time or to update a medication list, Med Recs are an important ongoing process to reduce the risk of medication errors. The final step is to create an up to date medication list, use our downloadable Medication List Template to document your Med Rec.

Step 1: The "Brown Bag" Gather

Before you look at a single piece of paper, grab a bag. Go through the house and collect every single thing the patient takes. This includes:

• Daily prescriptions.
• "As needed" meds (like inhalers or nitroglycerin).
• Over-the-counter bottles (Tylenol, Advil, etc.).
• Vitamins, herbs, and supplements.

Step 2: Create the "Ground Truth" List

Using a Medication List Template, list everything you found in the bag. Be specific. Don’t just write "Blood Pressure Pill." Write "Lisinopril, 10 mg, one tablet by mouth, every morning."

Step 3: The Comparison (The "Med Rec" Moment)

Now, take the Discharge Summary or the new orders from the doctor. Compare them to your "Ground Truth" list. For every medication, ask these four questions:

1. Is this new? (Did the hospital add this?)
2. Is this different? (Did they change the dose of my old medicine?)
3. Is this missing? (I used to take this, does the Discharge Summary say to discontinue this med?)
4. Is this a duplicate? (Am I now being told to take two different pills for the same thing?)

Step 4: Mark the Status

On your medication list, color-code or mark each entry:

Unchanged: Keep taking it as usual.

New: Start this today.

Changed: Stop the old dose, start the new one.

Stopped: Move this bottle to a separate "do not take" box.

Step 5: The Professional Hand-Off

You are not expected to make clinical decisions. If you find a discrepancy—for example, your doctor prescribed a new blood thinner but didn’t tell you to stop your daily Aspirin—do not guess. Call your primary care doctor or your pharmacist immediately. Say: "I am doing a medication reconciliation and I noticed a discrepancy. Can you confirm if I should be taking both X and Y?"

Step 6: Update the Medication List regularly:

Be sure to download and use our Medication List Template to document any changes.