Medicines reconciliation

Medicines reconciliation is typically undertaken by hospital pharmacist.

Medicines reconciliation is the process of ensuring that a hospital patient's medication list is as up-to-date as possible. It is usually undertaken by a pharmacist, and may include consulting several sources such as the patient, their relatives or carers, or their primary care physician. In the United Kingdom, guidelines on medicines reconciliation are provided by the National Institute for Health and Care Excellence (NICE) in collaboration with the National Patient Safety Agency.^[1] In accordance with these, it should be carried out within 24 hours of admission to hospital.

Importance

Research has shown that, on average, there is around a 20% discrepancy between medications prescribed on admission to hospital and the true medication list for a given patient.^[2] The most common omissions are inhalers and analgesia. There are also a small minority of errors in prescribing drugs such as insulin or warfarin, which could have catastrophic consequences including death of the patient. The value of medicines reconciliation is in noticing and correcting these errors before they have a chance to adversely affect the patient concerned.

References

1. National Patient Safety Agency. NICE NPSA medicines reconciliation adults in hospital. Patient Safety Alert, Reference number 1035. Issue date 1 December 2007. London, UK.
2. Urban R, Armitage G, Morgan J, et-al. Custom and practice: a multi-center study of medicines reconciliation following admission in four acute hospitals in the UK. Res Social Adm Pharm. 2014; 10: 355-68. PMID 24529643