Medication Reconciliation Workflow

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Overview

Medication reconciliation ensures the patient’s active medication list is accurate and consistent across all systems:

• ECW (clinical EMR)
• PioneerRx (pharmacy dispensing system)
• AllCare.ai (care coordination platform)
• Facility records (medication administration records/MAR)

This workflow is critical during:

• Patient enrollment or transfer
• Hospital discharge
• Provider transitions
• Routine audits
• Discrepancy reports

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Quick Reference

SLA: Complete within 48 hours of request
Escalation: Discrepancies requiring clinical decision → provider review within 24 hours
Systems: ECW, PioneerRx, AllCare.ai, Freshdesk

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Step-by-Step Procedure

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1. Receive Reconciliation Request

Common Triggers:

• Facility requests updated medication list
• Patient transferred from hospital
• Provider change or new provider assignment
• Scheduled quarterly reconciliation
• Discrepancy identified by pharmacy or facility

In Freshdesk:

• Open or create ticket for medication reconciliation request
• Confirm patient name, DOB, and reason for reconciliation

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2. Pull Current Medication Lists

From ECW:

• Open patient chart → Medications tab
• Export or document current active medications:
  • Medication name
  • Strength and dosage form
  • Dose and frequency
  • Start date
  • Prescribing provider
  • Number of refills

From PioneerRx:

• Search for patient
• Pull active prescription orders:
  • Medication name and NDC
  • Strength and quantity
  • Last fill date
  • Refills remaining
  • Prescriber

From AllCare.ai (if applicable):

• Navigate to patient profile → Medications or Medication Reconciliation tab
• Review documented medication list

From Facility (if needed):

• Request current MAR (medication administration record)
• Confirm what medications facility is actively administering

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3. Compare Lists Side-by-Side

Create Comparison Table:

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4. Identify Discrepancies

Common Discrepancy Types: A) Duplicates:

• Same medication listed multiple times
• Generic and brand name both active
• Old and new strengths both active

B) Omissions:

• Medication in one system but not others
• Recently prescribed but not in EMR
• Discontinued med still showing as active

C) Dosage Differences:

• Different strengths across systems
• Different frequencies (e.g., daily vs BID)
• Different routes (e.g., oral vs transdermal)

D) Status Mismatches:

• Active in EMR but no refills in pharmacy
• Discontinued in EMR but still dispensing
• Facility administering medication not in any system

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5. Investigate and Resolve Discrepancies

For Each Discrepancy: Step 1: Determine Source of Truth

• Check most recent provider encounter or order
• Review hospital discharge summaries
• Contact facility to confirm current administration
• Check PioneerRx fill history for recent changes

Step 2: Document Findings

• In AllCare.ai → Medication Reconciliation tab:
  • List each discrepancy
  • Note investigation findings
  • Document resolution needed

Step 3: Categorize Resolution Needed Can Resolve Directly:

• Update EMR to match current prescriptions
• Mark discontinued meds as inactive
• Add missing medications to EMR

Requires Provider Review:

• Clinical decision needed (continue vs discontinue)
• Dosage clarification required
• Potential drug interaction or duplicate therapy
• Safety concern identified

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6. Update Systems

For Discrepancies Resolved Directly: In ECW:

• Add missing medications with correct details
• Mark discontinued medications as inactive with date
• Update dosages/frequencies to match current orders
• Document source of correction (e.g., “Per PioneerRx active orders”)

In AllCare.ai:

• Update medication list to match reconciled version
• Add note: “Medication reconciliation completed [date]”

For Discrepancies Requiring Provider Review: Create Tele-Encounter in ECW:

• Encounter type: “Medication Reconciliation Review”
• List each item requiring provider decision:
  • Medication name and current status across systems
  • Specific question or concern
  • Recommended action (if applicable)

Assign to Provider:

• Assign to patient’s treating provider
• Set priority based on safety implications
• Include deadline for response

Monitor Provider Response:

• Check for provider decision
• Implement provider’s instructions across all systems
• Document final resolution

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7. Generate Reconciliation Report

Create Summary Document: Medication Reconciliation Report

• Patient: [Name, DOB, MRN]
• Date: [Reconciliation date]
• Performed by: [Your name]
• Reason: [Enrollment, discharge, routine, etc.]

Reconciled Medication List: Discrepancies Identified and Resolved:

1. [Discrepancy description] → [Resolution]
2. [Discrepancy description] → [Resolution]

Provider Review Required:

• [List any items still pending provider decision]

Next Steps:

• [Any follow-up actions needed]

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8. Distribute and Document

Send Report To:

• Facility (via secure email or fax)
• Provider (if review was required)
• Pharmacy (if dispensing changes needed)

In AllCare.ai:

• Upload reconciliation report to patient documents
• Add note summarizing reconciliation outcome

In Freshdesk:

• Attach reconciliation report
• Document:
  • Number of discrepancies found and resolved
  • Any pending provider reviews
  • Facility notification sent
• Change ticket status to Resolved (or Pending if awaiting provider)

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Systems Used

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ECW

• Source of clinical medication list
• Update with reconciled information
• Create tele-encounters for provider review

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PioneerRx

• Source of active pharmacy orders
• Verify fill history and refill status
• Identify dispensing discrepancies

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AllCare.ai

• Medication Reconciliation tab for documentation
• Upload final reconciliation report
• Track reconciliation history

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Freshdesk

• Track reconciliation requests
• Document findings and resolutions
• Coordinate with facility and providers

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Best Practices

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Timing

Perform medication reconciliation:

• Within 24 hours of hospital discharge
• Within 48 hours of patient enrollment
• After provider change
• Quarterly for all active patients
• Whenever discrepancy is reported

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Documentation

Always document:

• Date of reconciliation
• Systems compared
• Discrepancies found
• Resolution for each discrepancy
• Provider review (if required)
• Final reconciled list

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Communication

Notify all stakeholders:

• Facility: Updated medication list for MAR
• Provider: Discrepancies requiring clinical decision
• Pharmacy: Changes affecting dispensing
• Patient/family: Significant medication changes (via facility)

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Safety Considerations

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High-Priority Discrepancies

Escalate immediately:

• Duplicate therapy (e.g., two blood thinners)
• Contraindicated combinations
• Discontinued critical medication still being administered
• Significant dosage errors
• Allergies not documented

Actions:

• Call facility immediately if safety concern
• Create urgent tele-encounter for provider
• Document escalation in Freshdesk
• Follow up to confirm resolution

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Controlled Substances

Extra verification required:

• Confirm prescriber DEA authority
• Verify prescription monitoring program (PMP) compliance
• Ensure proper documentation in all systems
• Check for duplicate controlled substance prescriptions

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Troubleshooting

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Issue: Facility MAR doesn’t match any system

Solution:

• Contact facility to identify source of medications
• Check if patient has outside prescriptions
• Verify patient identity (ensure correct patient)
• Request copies of all prescription bottles/labels

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Issue: Provider unavailable for urgent reconciliation review

Solution:

• Contact Clinical Supervisor for coverage
• Escalate to on-call provider if safety concern
• Document escalation and interim actions
• Follow up when provider available

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Issue: Multiple systems show different information, unclear which is correct

Solution:

• Check timestamps/dates for most recent update
• Review provider encounter notes for context
• Contact facility to confirm current administration
• When in doubt, escalate to provider for clinical decision

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Issue: Patient has medications from multiple pharmacies

Solution:

• Request complete medication list from facility
• Contact other pharmacies if known
• Document all sources in reconciliation report
• Recommend consolidating to single pharmacy if appropriate

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Video Walkthrough

🔗 Medication Reconciliation Training Video

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Related Workflows

• New Prescription Requests
• Medication Refills
• Medication Changes
• Patient Enrollment
• Hospital Discharge