A 55-year-old male is admitted to the hospital for elective hip replacement. During medication reconciliation, the patient reports taking 'something for my blood pressure,' 'a water pill,' and 'a pill for my cholesterol.' He cannot recall the names or doses. His family later provides a list including ramipril 5 mg PO daily, hydrochlorothiazide 25 mg PO daily, and atorvastatin 20 mg PO daily. What is the most appropriate action for the admitting pharmacist based on this information?

Question: A 55-year-old male is admitted to the hospital for elective hip replacement. During medication reconciliation, the patient reports taking 'something for my blood pressure,' 'a water pill,' and 'a pill for my cholesterol.' He cannot recall the names or doses. His family later provides a list including ramipril 5 mg PO daily, hydrochlorothiazide 25 mg PO daily, and atorvastatin 20 mg PO daily. What is the most appropriate action for the admitting pharmacist based on this information?

Answer options:

• Document these medications as 'home medications' and proceed with hospital orders. ✅ Verify these medications with the patient's community pharmacy to confirm accuracy and last dose.
• Instruct the patient to continue taking these medications while in hospital unless otherwise directed.
• Recommend that the physician hold all home medications on admission.

Correct answer: Verify these medications with the patient's community pharmacy to confirm accuracy and last dose.

Explanation: Medication reconciliation on admission requires a thorough and accurate list of all home medications. Given the patient's poor recall and the potential for discrepancies, confirming the medication names, doses, frequencies, and last doses with a reliable source (e.g., community pharmacy, provincial drug database if available) is crucial to prevent medication errors and ensure continuity of care.