Mohammad Azeem, Pankaj Arora*, Yousif Alosaily, Rolla Mohammed Ahmad Alfahhad
Transitional care involves medication review and medication reconciliation with systematic implementation to improve patient safety and effectiveness on diverse levels. Medication reconciliation is a recognized process of procuring patients' complete history of medication lists and comparing it with current medications to perceive and avoid medication discrepancies and drug-related problems. Medication discrepancies during hospitalizations are most prevalent and lead to adverse drug events and rehospitalization. Literature has been developed stating the most effective methodologies in implementing medication reconciliation programs to strengthen the evidence for widespread adoption. The current narrative has been designed to gather evidence on the process of medication reconciliation, its significance, and the necessary plan and strategies for implementing medication reconciliation by clinical pharmacists at hospitals.