ISMP Medication Reconciliation 1 — Questions and Answers
Question 1: Medication reconciliation is defined as the process of:
- Filling prescriptions faster
- Comparing a patient's medication orders to all medications the patient has been taking to avoid discrepancies (Correct answer)
- Counting pills in the pharmacy
- Billing for medications
Correct answer: Comparing a patient's medication orders to all medications the patient has been taking to avoid discrepancies
Medication reconciliation involves comparing a complete medication list against new orders at every transition of care to identify and resolve discrepancies.
Question 2: According to ISMP, medication reconciliation is most critical at which points in a patient's care?
- Only at hospital admission
- At every transition of care: admission, transfer, and discharge (Correct answer)
- Only when a patient changes physicians
- Only during annual check-ups
Correct answer: At every transition of care: admission, transfer, and discharge
ISMP emphasizes that medication reconciliation must occur at every care transition—admission, transfer between units, and discharge—because each handoff creates error risk.
Question 3: A 'best possible medication history' (BPMH) used in medication reconciliation should ideally include information from:
- The prescriber's memory only
- Multiple sources: patient interview, caregiver, community pharmacy, and prior records (Correct answer)
- Insurance records only
- The patient's online social media
Correct answer: Multiple sources: patient interview, caregiver, community pharmacy, and prior records
A BPMH requires gathering information from multiple sources to create the most accurate possible medication list, as no single source is always complete or accurate.
Question 4: Which type of discrepancy found during medication reconciliation is considered most dangerous by ISMP?
- A change in pill color
- Omission of a critical chronic medication (Correct answer)
- A generic substitution
- A change in tablet scoring
Correct answer: Omission of a critical chronic medication
Omitting a critical chronic medication (e.g., anticoagulant, antiseizure drug, insulin) during care transitions can cause acute withdrawal, thromboembolism, seizures, or other serious harm.
Question 5: ISMP recommends involving patients and families in medication reconciliation because:
- It reduces pharmacist workload entirely
- They often know medications not captured in medical records, such as OTC drugs and supplements (Correct answer)
- Patients always have complete records
- It eliminates the need for pharmacist review
Correct answer: They often know medications not captured in medical records, such as OTC drugs and supplements
Patients and families are valuable sources for medications not in records, including OTC drugs, herbal supplements, and medications from multiple prescribers.
Question 6: According to ISMP, the most common cause of medication reconciliation errors at hospital discharge is:
- Too many pharmacists
- Incomplete communication of the discharge medication list to the patient and next care provider (Correct answer)
- Electronic health records
- Overly cautious physicians
Correct answer: Incomplete communication of the discharge medication list to the patient and next care provider
Errors at discharge frequently occur when the discharge medication list is incomplete, unclear, or not effectively communicated to the patient and receiving providers.
ISMP Medication Reconciliation 1
Medication reconciliation is defined as the process of: