Medicines reconciliation and medication reviews play an integral part in medicine optimisation.
Medicines optimisation looks at how people use medicines over time. The aim is to ensure that the right people get the right choice of medicine, at the right time. It focuses on people and their experiences, to help them to:
- improve their outcomes
- take their medicines correctly
- avoid taking unnecessary medicines
- reduce wasted medicines
- improve medicines safety
Medicines optimisation requires a multidisciplinary team working together to
- individualise care
- monitor outcomes more carefully
- review medicines more frequently
- support people when needed
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.
It involves recording a current list of medicines, including over-the-counter and complementary medicines. Then, the list is compared with the medicines the person is actually using. It involves recognising and resolving any discrepancies and documenting 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
- how and when the person prefers to or usually takes their medicine. This should include an assessment for self-administration
- the person's details, including full name, date of birth and address
- GP's details
- details of other relevant contacts, for example consultant, regular pharmacist or specialist nurse
- known allergies and reactions to medicines or ingredients and the type of reaction
- current medicines, including name, strength, form, dose, timing and frequency, route and indication
- changes to medicines and reason for change. Include medicines started, stopped or dosage changed
- 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
- information given to family members or carers involved in administering medicines
- other relevant information could include:
- when the medicine should be reviewed or monitored
- any support needed to administer the medicine themselves
Record the information from medicines reconciliation in the medicine administration record (MAR). 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
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.
A medication review is a structured, critical examination of a person’s medicines. The objective is to reach an agreement with the person about:
- optimising medicines
- minimising medication-related problems
- reducing waste
It involves a multidisciplinary team. The team could include a pharmacist, community matron or specialist nurse (such as a community psychiatric nurse), GP, member of the care home staff, practice nurse or social care practitioner.
It should involve the person or their family members.
The frequency of medication reviews should be based on the health and care needs of the person. Safety should be the most important factor when deciding how often to do the review. The frequency should be recorded in the care plan.
Medication reviews should be carried out at least once a year.
During a medication review, health and social care practitioners should discuss and review:
- the purpose of the medication review
- the person’s views and understanding about their medicines
- where appropriate, their family members’ or carers’ views and understanding
- any concerns, questions or problems with the medicines, including side effects or reactions
- all prescribed, over-the-counter and complementary medicines that people are taking or using
- what each of the medicines is for
- how safe the medicines are
- how well the medicines work
- how appropriate the medicines are
- whether use of the medicines is in line with national guidance
- any monitoring needed
- any help people need to take or use their medicines as prescribed. Include any extra help people need if they are self-administering
- any more information or support needed. For example, a person might need help using an inhaler or have difficulty swallowing
- Last updated:
- 13 July 2018