CPD activity

Before you start reading this article, think about:

• What do I want to learn?
• What will I gain from this learning?
• What will my employer gain?
• What difference will it make to people who use my services?

According to section 1.3 of the NICE guideline for Medicines optimisation: “Medicines reconciliation, as defined by the Institute for Healthcare Improvement, is the process of identifying an accurate list of a persons current medicines and comparing them with the current list in use, recognising any discrepancies, and documenting any changes, thereby resulting in a complete list of medicines, accurately communicated. The term ‘medicines’ also includes over-the-counter or complementary medicines, and any discrepancies should be resolved. The medicines reconciliation process will vary depending on the care setting that the person has just moved into.”

Medicines reconciliation can reduce errors during transfer of care. It also offers an important opportunity for pharmacy professionals to initiate a relationship with a patient – it might be the first time you meet the patient and/or their carer. This module will explore how medicines reconciliation can contribute to medicines optimisation.

Medication errors most commonly occur when patients are transferred between care settings. Such errors can cause injury to patients, and so reducing them has been a major driver for the formulation and implementation of national and local medicines reconciliation policies.

It is important that medicines reconciliation is conducted whenever a patient is transferred to a different care setting. In primary care, medicines reconciliation should be carried out for all people who have been discharged from hospital or another care setting. This should happen as soon as is practically possible, before a prescription or new supply of medicines is issued and within one week of a GP practice receiving the information. Community pharmacy teams can support this practice when they are informed of a patient’s admission to another care setting.

The NICE guidance provides pharmacy technicians and pharmacists with standardised criteria and systems for reconciling medicines. This guidance must be applied in daily practice in a systematic way, as this keeps channels of communication clear, which is the key to preventing medication errors and protecting patient safety.