Medication reconciliation is a targeted National Patient Safety Goal. This study describes the experiences of 50 Massachusetts hospitals that collaborated in an initiative to implement a medication reconciliation process. The authors provide a summary of their safe practice recommendations and share their reconciliation form and accompanying instructions for use. They discuss the role and importance of leadership support, assembling a multidisciplinary team, maintaining a narrow focus to foster rapid changes to the process, and implementing the process into everyday workflow. Overall, the authors provide a practical, step-by-step experiential guide for institutions and individuals committed to the important medication reconciliation initiative.