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Their EHR Incentive Program for Meaningful Use sets requirements for hospitals to complete medication reconciliation upon transitions of care. This process has proven complex, as providers are often confused who holds the responsibility for completing medication reconciliation. Admission: Any time a patient is admitted to the hospital, either through the Emergency Room or directly to the floor, the receiving nurse should review the patient’s home medication list with them. Physician: When the physician sees the patient, they should also perform medication reconciliation. Discharge: When the patient is being discharged, the final medication reconciliation should take place.

If the patient has a record with the hospital, the existing medications in the system should be updated.
The provider should decide which new prescriptions to write the patient, which of the home medications the patient should continue, and which medications they should discontinue at home. When discharging the patient, the nurse should review all of these new medication changes with the patient, so they are clear on what to take while at home. They can choose to order the medication the patient takes at home to take while they are in the hospital. They can also put any medications on hold that they don’t want the patient to take while at the hospital, but want them to continue to take at home, such as a multivitamin.

Lastly, they can discontinue any medications they don’t want the patient to take at home or in the hospital if they are contraindicated.

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