Medication Reconciliation

National QUM Indicators for Australian Hospitals

3.1 Percentage of patients whose medications are documented and reconciled at admission.

5.9 Percentage of patients who receive a current, accurate and comprehensive medication list at the time of hospital discharge.

National Safety and Quality Health Service Standards

4.6.1 A best possible medication history is documented for each patient.

4.8.1 Current medicines are documented and reconciled at admission and transfer of care between healthcare settings.

Medication Reconciliation

Helps reduce and prevent medication errors that can occur during the admission, re-charting, transfer of care and discharge processes and utilises at least one other source of information to confirm details, eg, a GP or retail pharmacist list, carer’s in-formation, dose administration aid details, current medication charts, etc.

A best possible medication history can be undertaken by a medical officer or pharmacist and includes the following:

  • A list of all medicines (prescribed and purchased) that a patient was taking prior to their admission to hospital;
  • Details of allergies or sensitivities to medicines (or excipients);
  • Recently stopped medicines (e.g. in the past month);
  • Recent short courses of antimicrobials or corticosteroids;
  • For some medical conditions, a list of previously tried medicines should also be included to help direct future prescribing (e.g. disease-modifying anti-rheumatic drugs [DMARDs] for rheumatoid arthritis; previous use of anticoagulants – warfarin and the novel oral anticoagulants – rivaroxaban, dabigatran, apixaban); and
  • Obtaining the best possible medication history is the first part of the medication reconciliation process. Various overseas and Australian studies have shown that the medication history error rate is anywhere between 40 to 60% when medication reconciliation is not undertaken.

Source: Edited extract from the Hornsby Ku-ring-gai Hospital Monday Memo