Clinical QuickieChronic Disease Management
Medication Reconciliation / Polypharmacy
Medication reconciliation is medication decision-making, not list verification.
Compare every source
Pre-admission list, discharge list, pharmacy fills, patient report, specialist changes, and newly discontinued drugs can conflict.
Ask the same questions for every drug
What is the indication? Correct dose/frequency? Duplicate? Interaction? Organ-function adjustment? Duration? Monitoring? Who owns follow-up?
Prioritize high-risk drugs
Anticoagulants, insulin/sulfonylureas, opioids, benzodiazepines, diuretics, RAAS agents, antiarrhythmics, digoxin, steroids, and immunosuppressants deserve deliberate review.
Deprescribing is an intervention
Remove drugs without a current indication, reduce duplicate/sedative/anticholinergic burden, and simplify therapy when harms exceed benefit.
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