Medication reconciliation is the process of comparing your medications from before the hospital to what you are prescribed at discharge. Errors during this transition are common and can cause serious harm. Knowing what to check before you leave protects your safety.
What Medication Reconciliation Means
Medication reconciliation compares your medication list from before admission to the medications you are discharged with, to identify discrepancies.
Discrepancies include new medications added during your stay, medications stopped or changed, and medications that should have been continued but were accidentally omitted.
Studies show that medication errors occur in 30 to 70 percent of hospital transitions without a formal reconciliation process.
Common errors include duplicate medications (taking two drugs from the same class unknowingly), incorrect doses, and medications stopped without clear instructions to restart.
You and your caregiver are an important part of catching errors. Ask questions before you leave.
Before You Leave: Questions to Ask
What medications have been added, changed, or stopped compared to what I was taking before?
What is each new medication for, and how long do I take it?
Which of my previous medications should I restart, and when?
Are there any medications I should not take together or at the same time of day?
What side effects should I watch for in the first week?
Who do I call if I have questions after I get home?
Transition Errors to Watch For
Double dosing: You may be discharged with a medication that duplicates something you already take under a different name. For example, Tylenol and a product containing acetaminophen could both be on your list.
Omitted home medications: Blood pressure, thyroid, psychiatric, or diabetes medications are sometimes held during a hospital stay and accidentally not restarted at discharge.
Dose changes not explained: A medication dose may be lower or higher than your pre-hospital dose without explanation. Ask whether the change is intentional.
New drug interactions: Medications added during your stay may interact with your long-term medications. Your pharmacist is the best resource to check for interactions.
Sharing Your List With Providers
Bring your discharge medication list to your first follow-up appointment and to the pharmacy.
Share the updated list with your primary care provider, especially if any long-term medications were changed.
A brown bag review, where you bring all your pill bottles to a pharmacy appointment, is one of the most effective ways to catch errors.
Keep a current medication list in your wallet or phone, including medication names, doses, timing, and the reason you take each drug.
Update your medication list whenever a provider makes a change, and notify all your providers of any additions or discontinuations.
Frequently asked
Questions patients ask.
What is the difference between a medication list and a reconciliation?
A medication list records what you take. Reconciliation is the active process of comparing your pre-hospital list to your discharge list, identifying discrepancies, and resolving them intentionally. A list alone does not catch errors the way reconciliation does.
Who is responsible for medication reconciliation at discharge?
The discharging provider (doctor, nurse practitioner, or pharmacist) is responsible for creating an accurate discharge list. However, patients and caregivers should review the list and ask questions. Mistakes are best caught by everyone working together.
What should I do if I find a discrepancy after I get home?
Call the discharging facility or your primary care provider to clarify the discrepancy before making any changes on your own. Do not stop or restart a medication without guidance, as some changes require a gradual transition or monitoring.
Should I bring my pill bottles to my follow-up appointment?
Yes, bringing your actual pill bottles is strongly recommended for your first follow-up after hospitalization or surgery. It allows your provider to verify name, dose, and frequency against the discharge list and catch any discrepancies in real time.
For patients
Get a personalized care plan.
This guide provides general information. For instructions tailored to your specific procedure, ask your provider about QR Rx care plans.
These medication guides are for educational purposes only and do not replace medical advice. Always follow your healthcare provider's specific medication instructions.
