Center for Education and Research on Therapeutics on
Healthcare Information Technology (CERT-HIT)
-Project 4-

Project 4. Ambulatory Medication Reconciliation Following Hospital Discharge

Medication reconciliation involves documenting all the medications a patient is taking including:
     • name
     • dosage
     • frequency
     • route
and using this list to provide an accurate medication history for the patient within the health care system.

The goals of this process are twofold:
    1. to verify that the medication reconciliation process             was done correctly according to the physician who
            is most familiar with the preadmission medication             regimen; and
    2. to clearly document in the outpatient medical
             record the new post-discharge medication regimen.

If this last piece is not correct it perpetuates the cycle of medication discrepancies.

An intervention will be designed and studied using health information technology (HIT) to facilitate post-discharge medication reconciliation.

The specific aim is to:
     • determine the effects of a post-discharge medication         reconciliation intervention, including the use of         information technology, on serious medication errors.


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