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Allergy and Medication Reconciliation Table
Paste allergies, home medications and current orders and get side-by-side tables, with every unresolved discrepancy flagged for the prescriber.
River's reconciliation table builder lines up a patient's home medications against the current orders and puts allergies in a table of their own. Each home medication is marked as continued, changed, held, stopped or not yet addressed, and each new order is marked as new, so the gaps between the two lists are visible at a glance.
It does not decide what the patient should take. A home medication that appears nowhere in the orders is flagged as unresolved for the prescriber, not assumed to be stopped. Allergies keep the reaction exactly as recorded, an unknown reaction is flagged, and any order that may conflict with a recorded allergy is called out for review.
This is for nurses and pharmacists at admission, transfer and discharge, and for clinicians checking a reconciliation before signing it.
Allergy and Medication Documentation
Proper allergy documentation includes three elements: allergen (what substance), reaction (what happened), and severity/type (how serious, what kind of reaction). Don't just list 'penicillin' as allergy; document 'penicillin: anaphylaxis' or 'penicillin: rash.' This helps providers assess whether exposure should be absolutely avoided or might be tolerated if needed. True allergies (IgE-mediated, anaphylaxis, serious reactions) differ from intolerances (GI upset, dizziness). Document both but distinguish them. Include medication allergies, food allergies, latex allergy, contrast dye reactions, and environmental allergies relevant to hospital care. Update allergy list whenever new allergies discovered or old ones disproven.
Medication reconciliation is systematic process of comparing complete list of medications patient is taking with medications ordered during care transition. This happens at admission, transfer, and discharge. Identify discrepancies between patient's home medication list and current orders. Some discrepancies are intentional (discontinuing medications, changing doses based on clinical situation). Others are unintentional errors that could harm patient (forgetting to restart home medications, duplicating therapies). Reconciliation prevents these errors. Document patient's complete home medication list, current hospital medications, and any changes made with rationale.
Create clear medication reconciliation tables comparing home to hospital medications. Include medication name, dose, route, frequency, and action taken (continued, discontinued, held, dose changed, new medication started). This documentation ensures receiving providers know what changed and why. At discharge, provide patient with updated medication list showing what to continue, what to stop, and what changed. Medication errors at transitions of care cause significant patient harm. Systematic reconciliation reduces unintended medication discrepancies, which are a common source of harm at transitions.
How it works
Paste the lists
Allergies, the home medication list and the current orders, in any format, identifiers removed if needed.
Get the tables
An allergy table and a side-by-side reconciliation, with every discrepancy marked unresolved.
Resolve with the prescriber
Take the unresolved rows to the prescriber, then record their decisions in chat.
What you get
- An allergy table with each substance, the reaction as recorded, and unknown reactions flagged
- Home medications against current orders, each marked continued, changed, held, stopped or unresolved
- New orders marked as new, so additions are as visible as omissions
- Possible allergy conflicts and duplicate therapies flagged for the prescriber to decide
Common questions
How do I distinguish true allergies from intolerances?
Record the reaction, not just the drug. Hives, swelling, wheezing or anaphylaxis suggest an immune reaction, while nausea or dizziness are usually side effects. Some reactions sit between: itching after morphine is commonly a direct histamine release rather than allergy. The table keeps the reaction exactly as recorded and leaves the classification to the clinician.
What if patient doesn't know their medication names?
Ask patient to bring in pill bottles or written medication list. Ask pharmacy to print medication list. Check with patient's primary care doctor or previous hospital records. Ask about what conditions they take medications for ('blood pressure pills,' 'diabetes medicine') and work backwards. Review medication administration records from nursing home or home health if applicable. Use all available sources to create most complete list possible. Document source of information and any limitations.
How do I document intentional changes vs errors in medication reconciliation?
For intentional changes, document rationale: 'Home lisinopril 20mg daily HELD due to acute kidney injury, will reassess' or 'Home metformin 1000mg BID DISCONTINUED due to AKI, started on insulin sliding scale instead.' For unintentional discrepancies you catch, document: 'Home atorvastatin 40mg daily was not initially ordered on admission, ADDED per med rec.' Clear documentation shows you identified and resolved discrepancy. This protects patient and demonstrates proper medication reconciliation.
Should I include over-the-counter medications and supplements?
Yes. Include OTC medications, vitamins, supplements, herbal products patients take regularly. Many interact with prescription medications or affect medical conditions. Aspirin, NSAIDs, calcium, vitamin D, fish oil, herbals all matter. Ask specifically about these as patients often don't mention them unless asked. Document complete list of everything patient actually takes. This prevents interactions and duplicate therapies and gives complete picture of patient's medication regimen.
Can I paste real patient details?
Follow your organization's policy first. If your organization has a business associate agreement with River, work within its terms. If not, remove names, record numbers, addresses, exact dates and other identifiers before pasting. The tables work the same with a patient number or no identifier at all.
Allergy and Medication Reconciliation Table
Describe what you need, add any files you have, and your workspace opens with the work already underway.