Accurate Identification

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.

Taking a Medication History

In 2015 the National Institute of Health and Care Excellence (NICE) issued updated guidance aimed at optimising the use of medicines. There is a section on medicines-related communication systems when patients move from one care setting to another. This covers both the transfer of a patient within an organisation and the transfer between different organisations including admission to and discharge from hospital, whether from home or from a different healthcare setting. The current care provider must share complete and accurate information about the person’s medicines with the new care provider. The new care provider must ensure this information is received and accurately documented and acted on appropriately. Ideally this information exchange should take place within 24 hours of transfer.

The Institute for Healthcare Improvement defines medicines reconciliation as:

  • Identifying an accurate list of a person’s current medicines and comparing them with the current list in use
  • Recognising and resolving any discrepancies
  • Accurately documenting any changes

This process should result in the accurate communication of a complete list of the patient’s medicines, including any over-the-counter or complimentary medicines.