Choosing Wisely:

Don’t continue medications based solely on the medication history unless the history has been verified with the patient by a medication-use expert (e.g., a pharmacist) and the need for continued therapy has been established.

Search Recommendations

Rationale and Comments: The patient or caregiver should be the sole source of truth when taking the medication history. The patient or caregiver should be interviewed by someone with medication-use knowledge, ideally a pharmacist, and medications should be continued only if there is an associated patient indication. If a pharmacist is not available, then at a minimum, the health care worker taking the history should have access to robust drug information resources. The history should include the drug name, dose, units, frequency, and the last dose taken; and indication if available.
Sponsoring Organizations:
  • American Society of Health-System Pharmacists
    • Sources:
  • Expert consensus
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    Disciplines:
  • Preventive Medicine
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    References: • ASHP statement on the role of the pharmacist in medication reconciliation [Internet]. Available from: www.ashp.org/DocLibrary/BestPractices/SpecificStMedRec.aspx.
    • Najafzadeh M, et al. Economic value of pharmacist-led medication reconciliation for reducing medication errors after hospital discharge. Am J Manag Care 2016;22:654-61.
    • Varkey, P, et al. Multidisciplinary approach to inpatient medication reconciliation in an academic setting. Am J Health-Syst Pharm. 2007; 64:850-5.
    • Lehnbom, EC, et al. Impact of medication reconciliation and review on clinical outcomes. Ann Pharmacother. 2014; 48:1298-1312.
    • The Joint Commission. 2017 National Patient Safety Goals [Internet; cited 2017 Jan 21]. Available from: www.jointcommission.org/standards_information/npsgs.aspx.
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