COMMUNITY CARE TRUST (SOUTH WEST) LTD
MEDICATION RECONCILIATION
POLICY No MED005
INTRODUCTION
The aim of medicines reconciliation on admission is to ensure that medicines prescribed
on admission correspond to those that the person was taking before admission. Medicines
Reconciliation ensures that people receive all intended medications and no unintended
medications following a move from one care setting to another. Details to be recorded
include the name of the medicine(s), dosage, frequency and route of administration.
Medication errors commonly occur when people are transferred from one care setting to
another, this is often a result of inaccurate medicine reconciliation. In view of that, the
National Patient Safety Agency (NPSA) recommends that all healthcare organisations have
a procedure in place for medication reconciliation on admission.
THE MEDICINES RECONCILLIATION PROCESS
The Community Care Trust has followed the three ‘3C’s’ approach as applied by the
National Prescribing Centre in developing the reconciliation process:
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Collecting
Checking
Communicating
Collecting
Collect information about the person’s medication history from all available sources (most
recent and reliable)
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Medical notes from the person’s previous care setting
Medicines containers or repeat prescription supplies available at the time of the
reconciliation
A computer print-out from the GP clinical records system
The tear-off side of a person’s repeat prescription request
Verbal information from the person, their family or a carer
Checking
Check that the medicines and doses prescribed for the person are correct. A doctor may
make some intentional changes to their medicines but any discrepancies must be
recorded.
Communicating
Communicate the final prescription through correct documentation on a Medication
Administration Record chart. If changes are made to the prescription, the doctor is
responsible for the documentation of such things as:
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When medicine has been stopped and for what reason
When medicine has been started and for what reason
The intended duration of treatment (e.g. for antibiotics or hypnotics)
When a dose has been changed and for what reason
When the route of administration has been changed and for what reason
When the frequency of the dose has been changed and for what reason
DOCUMENTATION
The admitting person must ensure that the following information is documented on
admission: Person details i.e. full name, date of birth, doctor and date of admission:
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A list of all the medicines prescribed for the person on discharge from the previous
care setting
Dose, frequency, formulation and route of all medicines listed
An indication of any medicines that are not intended to be continued
Any known allergies
Specific medication to ask about include:
 As required medication
 Inhalers
 Eye drops
 Topical preparations
 Once weekly medication
 Injections
 OTC medication
 Oral contraceptives
 Hormone replacement therapy
 Nebules
 Home Oxygen
 Herbal preparations
 Insulin
 Opioids
 Clinical Trials Medication
Additional information for specific drugs e.g. indication for medicines that are for shortterm use only (antibiotics) and date of last and next administration of once
weekly/fortnightly/monthly medication.
This information must be checked by a qualified nurse or STR* who is:
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Up-to-date in the knowledge of brand and generic names of commonly used
medicines
Able to correctly interpret the prescription, including dosage directions
Have knowledge in the legal requirements for the prescribing, recording,
administration and storage of medicines (including controlled drugs)
Has an understanding of what the medicine is intended to do and how it works
* If the person is admitted to a service by a STR worker, the medication information will be verified by
another suitably trained and competent staff member.
RESPONSIBILITIES
This information should be checked by a pharmacist as soon as practicable; it is the
pharmacist’s responsibility to then check for any discrepancies. The person must be seen
and registered with a GP, ideally within 48hrs of admission. It is the GP’s responsibility to
then check the medications and prescribe all further intended medications.
At Cypress the person must be seen within a week by the consultant psychiatrist. It is the
consultant’s responsibility to check medications against discharge letters from previous
consultants to ensure that the prescribed medications correspond with those the person
was taking before admission.
Date of last review: July 2014
Version number:
02
Date of next review: July 2017
Signature ………………………………….