Medicines reconciliation

Medicines reconciliation is the process of accurately listing a person’s current medicines. This could be when they are admitted into a service or when their treatment changes.

NICE (National Institute for Health and Care Excellence) Guidance NG5: Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes recommends sharing relevant information about medicines when people move from one care setting to another. This is because medicines errors can happen when people move between services.

Medicines reconciliation should therefore be completed as soon as possible when people have been discharged from hospital or another care setting.

The medicines reconciliation process will vary depending on the type of care setting that the person has moved into (or from). But as part of the process, you should always:

• record a current list of medicines, including:
  • prescribed medicines
  • over the counter medicines
  • complementary or herbal medicines.
• compare this list with the medicines the person is taking and any discharge records. This should include a conversation with the person and their carer or family to check if they take their medicines as prescribed.
• recognise and resolve any discrepancies following your policy.
• document any changes.

Who can carry out medicines reconciliation

Trained and competent staff should carry out the medicines reconciliation. They should consult with a health professional. Ideally, this should be the person’s GP, nurse or pharmacist.

These staff will need knowledge, skills and expertise including:

• effective communication skills
• technical knowledge of processes for managing medicines
• therapeutic knowledge of medicines use.

When to reconcile medicines

The medicines reconciliation process should be completed:

• when a person is discharged from hospital or transferred from another setting or place of residence (including their home)
• when treatment has changed, for example dose changes or when starting to take new medicines
• before the first dose is administered or as soon as possible afterwards

Information to include

• Contact details for relevant healthcare professionals
• Known allergies and reactions to medicines or ingredients and the type of reaction
• Current medicines, including:
  • name
  • strength
  • formulation
  • dose
  • timing and frequency
  • route of administration
  • indication - what the medicine is for
• How and when the person prefers to take their medicines. This should include an assessment for self-administration
• Changes to medicines and the reason for changes, including details about:
  • medicines started
  • stopped medicines
  • dose changes
• Date and time the last dose of any 'when required' medicine was taken, including specific instructions to support their administration.
• Information about any medicine given less often than once a day - weekly or monthly medicines
• information given to the person, family members or carers
• when the medicine should be reviewed or any monitoring
• any other relevant information, for example smoking status, alcohol intake

Record keeping

Record the information from medicines reconciliation in the person’s medicines care plan. Make sure to record:

• details of the person completing the medicines reconciliation (name, job title)
• the date of the medicines reconciliation
• source(s) of information about the reconciled medicines

Check the medicines administration record (MAR) to make sure it contains accurate information.

Governance

Coordinate medicines reconciliation as part of a full needs assessment and care plan. This should be carried out by the care home manager or the member of staff responsible for a person's transfer into a care home. The governance process should be determined locally and include:

• organisational responsibilities
• responsibilities and accountability of health and social care practitioners involved in the process
• individual training and competency needs
• the resources needed to ensure that medicines reconciliation occurs in a timely way

You should monitor the effectiveness of the processes, for example through regular audit.