Recently I have been receiving a number of questions about whether the process of medication reconciliation falls within medical assistants’ scope of practice. This is an important issue worthy of discussion. The following is my position on the issue:
The Joint Commission defines medication reconciliation as follows:
The process of comparing a patient’s medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.
It is my legal opinion that knowledgeable and competent medical assistants can be assigned steps 1 and 2 as long as step 2 entails compiling a list of prescribed medications from the prescription orders of providers. However, steps 3 and 4 require the exercising of independent professional judgment and the making of clinical assessments. Therefore, in my judgment, medical assistants cannot be assigned 3 and 4. In regard to step 5, medical assistants can communicate verbatim new lists of medications as specifically approved by the overseeing/delegating provider, and only when the provider directs the medical assistant to do so.