# Review the medication-reconciliation quality data and determine the strongest improvement response.

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=547005&lang=en  
> language: en  
> subject: Performance Improvement  
> category: MOC

## Question

Review the medication-reconciliation quality data and determine the strongest improvement response.

| Time | Data |
| --- | --- |
| May audit | 12 of 100 discharges have an unresolved unintended discrepancy; one duplicate anticoagulant order; one medication-related return within 7 days. |
| June audit | 21 of 100 discharges have an unresolved unintended discrepancy; three duplicate anticoagulant orders; two medication-related returns within 7 days. |
| July audit | 29 of 100 discharges have an unresolved unintended discrepancy; five duplicate anticoagulant orders; four medication-related returns within 7 days. |

Q1. How should the council interpret the trend?

Medication-reconciliation reliability and safety outcomes are worsening
The increase reflects harmless documentation variation
Reconciliation is improving because more discrepancies were recorded
No action is needed until a fatal event occurs

Q2. Which intervention best addresses the pattern?

Send a one-time reminder to be careful
Discipline the last nurse who signed each discharge
Standardize the multidisciplinary workflow, assign ownership, and resolve discrepancies before discharge
Stop auditing high-risk medications

Q3. Which measure best evaluates improvement?

Number of reminder emails sent
Rate of unintended discrepancies resolved before discharge plus medication-related adverse returns
Percentage of forms containing any signature
Number of staff attending one lecture

## Explanation

The run of increasing unintended discrepancies, duplicate anticoagulant orders, and related return visits indicates a system reliability problem rather than isolated staff forgetfulness. A strong response maps the workflow, assigns accountability at each transition, standardizes collection and comparison of the medication history, resolves discrepancies before discharge, and includes pharmacy and frontline staff. The council should track both process reliability and balancing or harm outcomes. Education alone, punishment, or measuring only whether a form was signed is unlikely to correct the process defect.

## In-depth explanation

Correct Answer
The reconciliation process is worsening and needs a standardized multidisciplinary redesign with accountable measurement.

Why It Fits
Discrepancy rates and high-risk duplicate orders rise together with medication-related return visits across three months.

Clinical Picture
A completed checkbox does not prove that histories were accurate, discrepancies were resolved, or harm was prevented.

Memory Link
Reconcile means obtain, compare, resolve, communicate, and measure.

NCLEX Rule
Medication reconciliation improvement should standardize the transition process, clarify ownership, involve affected disciplines, and monitor meaningful process and outcome measures.

Why the Alternatives Fail
A memo, individual blame, or signature counts alone cannot demonstrate that unintended discrepancies were identified and corrected.

Sources
1AHRQ MATCH Medication Reconciliation Toolkit
2NCSBN 2026 NCLEX-RN Test Plan

## Clinical scenario

Performance-improvement council
A medical unit reviews monthly audits of 100 consecutive discharges. An unintended discrepancy is a medication-list difference that the prescriber did not intend after comparing the best possible medication history with transition orders.

## Key concepts

- **Best possible medication history** — The most complete and accurate medication list obtainable through systematic interviewing and verification.
- **Unintended discrepancy** — A difference between medication lists or orders that was not deliberately chosen by the prescriber.
- **Process measure** — A metric showing whether a required care step was reliably performed, such as discrepancies resolved before discharge.

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