Medication Reconciliation, by Dr. Jebaily and Dr. McClary, Jr.


(12/12/11) –
Doctor: "Hi Mrs. Jones, I heard you just went to the neurologist."

Mrs. Jones: "I did. They started me on that new medicine. It’s working great!"

Doctor: "What was the name of it?"

Mrs. Jones: "I don’t remember the name of it, but it was that little white pill, you know. You should have it in your computer system. Don’t all of you doctors have access to each other’s stuff on the computers?" If only that were the case!

What was just described is a scenario that occurs in almost every primary care doctor’s office on a daily basis. And, it is hands-down one of the most potentially dangerous aspects of any doctor-patient visit, be it in the office or in the hospital. The danger lies in the fact that medication errors occur very easily when 1) a patient does not know what medications he/she is taking (or why for that matter) and/or 2) healthcare providers caring for the patient do not have an accurate list of medications.

Imagine the prospect of being prescribed a blood thinner by one physician when, unbeknownst to them, you happen to already be taking one from someone else. The results can be deadly.

It is a huge area of concern for any practicing physician, no matter what his/her specialty may be. Any medication, even over-the-counter ones, have the potential for very serious side effects, not to mention interactions with other medications. And this effect is only amplified when patients are on multiple medications (which is a whole other issue in itself!). Sadly, we see this scenario far too often.

Over a third of adults take five or more medications! In addition to prescription medicines, many people self-medicate with over-the-counter drugs, vitamins, herbals, and nutritional supplements. The medication process is a complex set of steps that involves multiple individuals having a role in the system, including doctors, nurses, pharmacists, patients and their family. As with any complex process, errors can occur at any time (prescribing, dispensing, administering) or in any place (inpatient, outpatient) in the medication process. Errors are especially common among older adults, due to their high rate of multiple medication use, co-morbidities, and multiple healthcare providers. Now, with mail order pharmacies, the task is even more difficult to have updated medication lists because some medications are mail-in and some are received at the local pharmacy.

So, this bodes the question, "How do we prevent this from happening?" One answer is performing diligent MEDICATION RECONCILIATION defined as a multistep process that entails obtaining a complete and accurate list of the medications a patient is taking … (and comparing this list with) … the patient’s medical record. Three steps to the process are

1. Verification
2. Clarification
3. Reconciliation

Verification is probably the most important and challenging step because patients may not be able to provide an accurate history of medication use nor maintain a documented list of his/her medications. This breakdown in communication between patients and providers regarding medications leads to errors and adverse events that can have serious consequences.

Clarification involves communication about how often, what time, what route, etc. (rather self explanatory).

Reconciliation is when the previous list in the patient’s chart is cross-referenced with the patient’s actual home medications. If there is any discrepancies, the changes are made accordingly.

More than 40% of medication errors are thought to result from inadequate reconciliation in handoffs during admission, transfer, and discharge of patients in inpatient setting. Around 20% of these cause harm. Data for the outpatient setting is likely higher because of the increase in variables associated with medication use.

What was mentioned above is a reality but please do not think that every patient is doomed to have problems with medications and adverse reactions. You can help keep yourself safe by being actively involved with your healthcare rather than being a spectator. The following are some steps every patient can perform to ensure he/she is doing his/her part to keep accurate and up to date information in the medical record.

1. Keep an updated list of medications with you at all times.
2. Bring ALL of your medications to every doctor visit, including over-the-counters, vitamins, etc.
3. ASK QUESTIONS. Believe it or not, we can tell when a patient does not understand instructions about medication regimens. Our job is to educate patients about illness, treatment options, and help you make the best decision for YOUR personal health care goals.
4. Know WHY you are taking a medication.
5. At the end of the visit, ask for a summary of what changed in your medications, as this may help to clarify questions you have after leaving the doctor’s office.


McLeod Health is very pleased to announce that Dr. Patrick J. Jebaily and Dr. Guy E. McClary, Jr. have opened McLeod Family Medicine West in Florence. Both are natives of the area and completed their residencies at the McLeod Family Medicine Residency Program. Dr. Jebaily and Dr. McClary look forward to being part of the Pee Dee community and to welcoming families as new patients. McLeod Family Medicine West is located at 3013B West Palmetto Street, in Florence, behind the McLeod Urgent Care Center. For more information, or to make an appointment, please call (843) 777-7370.