ASHP Statement on the Pharmacist’s Role in Medication Reconciliation Position The American Society of Health-System Pharmacists (ASHP) believes that an effective process for medication reconciliation reduces medication errors and supports safe medication use by patients. ASHP encourages hospitals and health systems, including community-based providers and managed care systems, to collaborate in organized, multi- disciplinary medication reconciliation programs to promote continuity of patient care. ASHP further believes that phar- macists, because of their distinct knowledge, skills, and abilities, are uniquely qualified to lead interdisciplinary ef- forts to establish and maintain an effective medication rec- onciliation process in hospitals and across health systems. Pharmacists should lead or assume key roles in the follow- ing essential components of medication reconciliation: de- veloping policies and procedures, implementing and con- tinuously improving medication reconciliation processes, training and assuring the continuing competency of those involved in medication reconciliation, providing operational and therapeutic expertise in the development of information systems that support medication reconciliation, and advo- cating for medication reconciliation programs in the com- munity. Pursuant to their leadership role, pharmacists share accountability with other hospital and health-system leaders for the ongoing success of medication reconciliation pro- cesses across the continuum of care. Background The term “medication reconciliation” is defined by the Joint Commission as “the process of comparing the medications a patient is taking (and should be taking) with newly ordered medications” in order to resolve discrepancies or potential problems. 1 The goals of medication reconciliation are to obtain and maintain accurate and complete medication in- formation for a patient and use the information within and across the continuum of care to ensure safe and effective medication use. Although it is sometimes associated with survey and accreditation activities, medication reconcili- ation is an important component of patient safety and has demonstrated effectiveness in preventing adverse drug events. When organizations do not consistently and reliably reconcile patient medications across the continuum of care, medication errors and adverse drug events occur: approxi- mately half of all hospital-related medication errors and 20% of all adverse drug events have been attributed to poor com- munication at the transitions and interfaces of care. 2,3 In 1999, the Institute of Medicine report To Err Is Human: Building a Safer Health System 4 identified medication errors as the most common type of health-system error, contributing to several thousand deaths each year. The fiscal impact of these errors is also significant. With reported costs of $2595–4685 per adverse drug event, drug-related morbidity and mortal- ity were estimated to cost over $177 billion in 2000 alone. 5 Reports and studies such as these had a profound im- pact on the medical community, and the call for action was immediate. Organizations such as the Institute for Healthcare Improvement, the Agency for Healthcare Research and Quality, and the Joint Commission launched initiatives for performance improvement and established higher expecta- tions through new regulatory standards for improved com- munication between providers and patients and across health care systems. In 2005, the Joint Commission made medication reconciliation a focus of one of its National Patient Safety Goals. The initial goal included a number of detailed and specific requirements, which made implementation chal- lenging and resulted in numerous findings of noncompliance during survey. In response, the Joint Commission affirmed the importance of the goal but suspended it in 2009 and 2010 for extensive revision. After a comprehensive literature re- view and analysis of data collected by surveyor teams, a modified goal was released in 2011, and scoring of the goal began in July 2011. 6 The revised goal sets an expectation for maintaining accurate medication information at critical risk points in the medication-use process while allowing organizations latitude to define processes and encouraging performance improvement. The purpose of this statement is to describe pharma- cists’ responsibilities and accountabilities in medication rec- onciliation practices. Pharmacists’ Responsibilities When performed by pharmacists, medication reconcili- ation can reduce the frequency and severity of hospital medication errors that could potentially result in patient harm. 7 Pharmacists have demonstrated high rates of patient interventions; interventions per patient; and documentation of medications, medication interactions, drug-related admis- sions, and previous drug failures. 8 ASHP and the American Pharmacists Association be- gan a collaborative effort in 2007 and 2008 to create a shared vision for the role of the pharmacist in medication recon- ciliation processes. 9 That vision recognizes that pharmacists should take a leadership role in improving medication recon- ciliation, acting as both advocates and medication experts, to provide information to and educate patients and health care providers. Specifically, pharmacists’ responsibilities were described as including but not being limited to • Providing leadership in designing and managing pa- tient-centered medication reconciliation systems, • Educating patients and health care professionals about the benefits and limitations of the medication recon- ciliation process, and • Serving as patient advocates throughout transitions of care. Using this vision as a guide, ASHP has developed the fol- lowing recommendations for pharmacists’ functions in med- ication reconciliation activities. Medication Therapy and Patient Care: Specific Practice Areas–Statements 365