Medicines reconciliation: a guide for the foundation year doctor

Abstract

Most doctors are familiar with the concept of taking a patient's drug history on admission. Medicines reconciliation is about obtaining up-to-date, accurate and reliable information on patients' medication. According to the National Institute for Health and Clinical Excellence and the National Patient Safety Agency (2007), in their joint guidance, ‘the aim… is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission’. This is an important aspect of patient safety, so that patients receive all the correct medication, with none omitted and nothing additional administered by mistake. Medicines reconciliation has the potential to reduce medication errors (National Prescribing Centre, 2008).

Prescribing errors on admission to hospital and their potential impact: a mixed-methods study

“…Although almost all doctors interviewed indicated that they would sometimes or always use more than one source to confirm medication histories, the observations showed that a single source was used in almost half the cases. This is at variance with national guidance for England and Wales8 and other published guidance10 12 13 which suggests that at least two sources should be used. WHO definition for ‘Best Possible Medication History’ states that the patient should be interviewed where possible, and advocates the use of more than one source 5…”

“…Limited information is available in the literature regarding the most effective way to train medical students to prescribe29 30; only two papers providing specific medicines reconciliation guidance for medical students or junior doctors have been identified 12 13. These papers confirm the need for at least two sources to be used and highlight some of the common pitfalls.…”