Medication therapy management and reconciliation

It is rare that a Case Manager would have a client who is not taking any medications. In fact it is much more likely to have a client who is taking multiple medications, for multiple conditions, prescribed by multiple providers. It is important to review all medications prescribed as well as over the counter medications and supplements the patient is taking.

The case manager should also assess the clients understanding of why they are on each medication, and how to take it properly. It is also important to assess their compliance with taking the medications as ordered. If a patient is noncompliant it is important to know why. Can they not afford the medication? Does it cause a side effect the patient does not like? Do they feel better and therefore do not believe they need it? Or do they just forget to take or refill it? Once the reason for noncompliance is identified, the case manager should notify the prescribing doctor, and assist the patient with strategies to become compliant.

Medication Reconciliation

What is Medication Reconciliation?

As defined by JCAHO, medication reconciliation is “the process of comparing a patient’s medication orders to all of the medications that the patient has been taking”. This is to include name, dosage, route and frequency. These medications should be checked for compatibility.

When Should Medication Reconciliation Occur?

  • Any time the patient is moved within the hospital, such as from the ICU to the stepdown unit.
  • Upon transfer to another facility.
  • Upon discharge from any facility.
  • At each doctor office visit.

Why should Medication Reconciliation be done?

The goal of medication reconciliation is to reduce adverse drug events by reducing medication errors such as omission, duplication, drug interactions and dosing errors. Most errors occur during patient transitions in care, including changes in setting, level of care or practitioner.