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According to The Joint Commission (2006), medication reconciliation is the process of comparing a patient’s medication orders to all of the medications that the patient has been taking.

This reconciliation is done to identify and resolve medication discrepancies, which are unintended or unexplained differences among documented medication lists across different sites of care guidelines and clinical appropriateness of therapy. Importantly, intensive pharmacotherapy is concerned with how the medication treatment of one diagnosis may actually interfere or be compromised by medications prescribed for co morbid diagnoses.

Medication reconciliation should be done at every transition of care in which new medications are ordered or existing orders are rewritten, the ultimate goal being a single discrepancy-free medication list shared by all disciplines across all sites of care.

Care transitions present multiple challenges for patients, care- givers, and healthcare providers, including securing the level of collaboration needed to produce a discrepancy free, therapeutically sound medication list.
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