The aim of medicines reconciliation on admission is to ensure that medicines prescribed on admission correspond exactly to those that the patient was taking before admission, or, if not, that variance is due to deliberate medication review rather than an error.
Medication review is defined by NICE as ‘a structured, critical examination of a person’s medicines with the objective of reaching an agreement with the person about treatment, optimising the impact of medicines, minimising the number of medication‑related problems and reducing waste’.
Medicines reconciliation is referred to as the best possible medication history. In the past, junior doctors often conducted a quick medication history as part of the admission process, leaving fine details to be confirmed later. However, with the advent of electronic prescribing, this approach is no longer acceptable. An electronic prescribing system requires precise medication details. Junior doctors must therefore improve their competence in taking a full and complete medication history.
NICE guidance recommends that the refinement process should ideally occur within 24 hours of admission and be led, for example, by a pharmacist or another competent healthcare professional within the multidisciplinary team.