Whose job is medication reconciliaton anyway?

November 5, 2007

Pharmacists should own up to the job of medication reconciliation since they are the most knowledgeable of all health professionals on this subject.

An argument could be made that the first two steps are no more than making lists, the third step is simply looking for differences in those lists, and step five is communicating them. Step four appears to be the only one requiring a trained healthcare professional to carry out the function involved.

So who is best qualified to fulfill these five steps? Successful execution of these five steps mandates a knowledge base that is, I believe, unique to the pharmacist. Certainly other professions can and do bring something to the table. I'm not saying that pharmacists are the only option. However, the person "responsible" for execution and the outcome should be a pharmacist since pharmacists are the best trained in medication management. To quote the old Carly Simon song, "Nobody does it better!"

But accepting that "medrec" is our responsibility is only half the battle. What does responsibility mean? If we are to accept responsibility, we cannot do so by remote control. I have seen too many pharmacists claim responsibility for medrec when all they've done is sit on a committee that designed a process of developing a medication listing on the front end. Meanwhile they've deferred the work of medrec to nurses, aides, and others.

Why are so many pharmacists content to sit on the sidelines and watch? Why are we not stepping up to use our professional expertise to deal with the issue of poor communication of medical information at transition points that is responsible for so many medication errors and adverse drug events?

Ultimately, the most common argument against having pharmacists do this is lack of resources-code for "money." While we have to be fiscally prudent, our ultimate responsibility must be to provide the best possible patient care. At the end of the day, resource allocation is not about how much money there is-there is a lot of money in health care-it is about how the money is allocated; it is about priorities. Shame on hospital administrators for not recognizing that having pharmacists actively engaged in this process should be a priority. And shame on us for not being able to convince our bosses, our colleagues, and our patients that our skills are worth paying for because we can reduce medication errors and adverse effects due to medications.