Medicines reconciliation

It is estimated that 67% of patients’ prescription medication histories have one or more errors and up to 46% of medication errors occur when new orders are written at patient admission or discharge. (Joint Commission International Center for Patient Safety).

It is crucial that patients are prescribed the correct medicines, in the correct doses appropriate to their current clinical presentation and that avoidable harm from medicines is reduced.

Through extensive consultation with clinicians from many disciplines, patients and representative from the Royal College of Physicians of Edinburgh a national definition has been developed which includes goals and measures and a series of recommended steps.

Medicines Reconciliation Definition:

The process that the healthcare team undertakes to ensure that the list of medication, both prescribed and over the counter that I am taking is exactly the same as the list that I or my carers, GP, Community Pharmacist and hospital team have. This is achieved in partnership with me through obtaining an up-to-date and accurate medication list that has been compared with the most recently available information and has documented any discrepancies, changes, deletions or additions resulting in a complete list of medicines accurately communicated.

Goals and Measures:

Compliance with medicines reconciliation should be measured using case note review of 20 case notes per calendar month. The verification of the medicines reconciliation by a pharmacist provides the definition of accurate medicines reconciliation. If pharmacist verification has not been completed (for example in areas with no clinical pharmacy services) then an assessment of accuracy would require by the first MDT after admission.

Chief Medical Officer letter issued September 2013 (SGHD/CMO(2013)18)