Key messages

  • Medication reconciliation matches the right patient with the right medication.
  • Medication reconciliation ensures a patient’s current medicines are accurate.
  • Medication reconciliation is important when a patient’s care is transferred between hospitals or home.

Medication reconciliation is a formal process for obtaining and verifying a complete and accurate list of each patient’s current medicines. Medicines should be matched to the person they are actually prescribed to.

When care is transferred between wards, hospitals or home, a current and accurate list of medicines, including reasons for change, is provided to the health professional or carer taking over the patient’s care.

Any discrepancies are to be reviewed and discussed with the prescriber and reasons for changes to therapy documented.

Why is medication reconciliation important?

Medication reconciliation is important because:

  • up to two-thirds of medication histories have at least one error, and up to one-third of these errors have the potential to cause harm
  • more than 50 per cent of medication errors occur at transitions of care
  • patients with one or more medicines missing from their discharge prescription are 2.3 times more likely to be readmitted to hospital
  • 85 per cent discrepancies in medication treatment originate from poor medication history taking.

How to design a medication reconciliation process

The Agency for Healthcare Research and Quality (AHRQ) in the United States developed the MATCH toolkit, which provides the following guiding principles for designing a successful medication reconciliation process.

  • Develop a single medication list (‘one source of truth’), shared by all disciplines for documenting the patient’s current medications.
  • Clearly define roles and responsibilities for each discipline involved in medication reconciliation.
  • Standardise and simplify the medication reconciliation process throughout the organisation and eliminate unnecessary redundancies.
  • Make the right thing to do the easiest thing to do within the patterns of normal practice.
  • Develop effective prompts or reminders for consistent behaviour.
  • Educate consumers and their families or caregivers on medication reconciliation and the important role they play in the process.
  • Ensure the process design meets all pertinent regulations.
  • Link medication to other strategic goals or initiatives - such as accreditation - to strengthen support for the process.