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Medicines reconciliation (how to check you have the right medicines)

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

NICE 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. Medicines reconciliation should be completed as soon as possible when people have been discharged from hospital or another care setting. Medicines errors can happen when people move between services.

You should record a current list of medicine, including:

  • prescribed
  • over-the-counter
  • complementary medicines.

You should compare this list with the medicines the person is taking. This should include a conversation with the person to check if they take their medicines as prescribed.

You should recognise and resolve any discrepancies and document any changes.

The medicines reconciliation process will vary depending on the care setting that the person has moved into (or from).

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.

Where appropriate, people, their family members and carers should be involved.

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 home)
  • when treatment has changed, for example dose changes
  • before the first dose is administered or as soon as possible afterwards

Information to include in medicines reconciliation

  • contact details for relevant healthcare professionals
  • known allergies and reactions to medicines or ingredients and the type of reaction
  • current medicines, including:
    • name
    • strength
    • form
    • dose
    • timing and frequency
    • route
    • indication - what the medicine is for
  • how and when the person prefers to or usually takes their medicine. This should include an assessment for self-administration
  • changes to medicines and reason for change, including:
    • medicines started
    • stopped
    • dose changes
  • date and time the last dose of any 'when required' medicine was taken -include specific instructions to support the administration of these
  • 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

Record keeping

You should record the information from medicines reconciliation in the 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

You should 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 staff member responsible for a person's transfer into a care home. The governance process should be determined locally and include:

  • organisational responsibilities
  • responsibilities of health and social care practitioners involved in the process
  • who those health and social care practitioners are accountable to
  • individual training and competency needs
  • resources needed to ensure that medicines reconciliation occurs in a timely manner

You should monitor the effectiveness of the processes and review them regularly.

Last updated:
14 July 2020