Medicines reconciliation or medication reconciliation is the process of ensuring that a hospital patient's medication list is as up-to-date as possible. It is usually undertaken by a pharmacist and may include consulting several sources such as the patient, their relatives or caregivers, or their primary care physician.
Research has shown that, on average, there is around a 20% discrepancy between medications prescribed on admission to hospital and the true medication list for a given patient.[5] Chronic medications are stopped in about 11% of the patients after elective surgeries[6] and 33% of the patients after admission to intensive care unit.[7] The most common omissions are inhalers and analgesia. There are also a small minority of errors in prescribing drugs such as insulin or warfarin, which could have catastrophic consequences including death of the patient. Pharmacist involvement help reasons for drug discontinuation being documented[8] and adverse drug reactions being reconciled in the prescription charts.[9] The value of medicines reconciliation is in noticing and correcting these errors before they have a chance to adversely affect the patient concerned. Research shows that the main activity of medicines reconciliation by pharmacists is to identify or assess drug-related problems and discuss them with other professionals. However, the process and the tools used in medicines reconciliation vary greatly. There is a wide variation in how medicines reconciliation is conducted and which methods are utilized in different country and hospitals.[10]
References
^National Patient Safety Agency. NICE NPSA medicines reconciliation adults in hospital. Patient Safety Alert, Reference number 1035. Issue date 1 December 2007. London, UK. [1]
^Urban, R; Armitage, G; Morgan, J; et al. (2014). "Custom and practice: a multi-center study of medicines reconciliation following admission in four acute hospitals in the UK". Res Social Adm Pharm. 10 (2): 355–68. doi:10.1016/j.sapharm.2013.06.009. PMID24529643.
