Ask any hospitalist where medication errors originate and the answer will involve a transition — admission, transfer, or discharge. The reconciliation interview itself is generally performed competently. The information simply does not survive the journey.
Three sources, three truths
The prescribed list comes from the ordering system. The dispensed list comes from pharmacy claims. The taken list comes from the patient. All three are partially correct and none is authoritative. Reconciliation is the act of resolving them, which means someone has to be accountable for the resolution.
A medication list with no owner is a historical document, not a clinical one.
Making the handoff survivable
- Reconcile at discharge with the outpatient clinician’s list visible, not only the inpatient one.
- Flag deliberate discontinuations explicitly — an absent medication is ambiguous.
- Send the reconciled list to the receiving clinician in structured form, not as a PDF attachment.
- Schedule the follow-up before discharge; reconciliation without a review appointment is incomplete.
The high-yield subgroup
Polypharmacy with recent change
Patients on eight or more medications who had a change in the last thirty days account for a disproportionate share of preventable harm. If capacity is limited, start there rather than attempting universal coverage badly.
