Assuring Medication Accuracy at Transitions of Care: Medication Reconciliation

"The interface between different care settings is particularly prone to error and a potential target for interventions to reduce medication error.”

(Easton, K., T. Morgan, et al. (2008). Medication safety in the community: A review of the literature. Sydney, National Prescribing Service).

Communication problems between settings of care, or between health professionals, are a significant factor in causing medication errors and adverse drug events. Unintentional changes to patients' medicines regimens often happen during hospital admissions. These unintended changes can cause serious problems during a hospital stay or when patients are discharged.

The process of medication reconciliation has been shown to reduce errors and adverse events associated with poor quality information at transfer of care and inaccurate documentation of medication histories on patient admission to hospital.

Assuring medication accuracy at transitions of care through the process of medication reconciliation is one of five patient safety priorities nominated by the World Health Alliance on Patient Safety.

What is medication reconciliation?

Medication reconciliation is a formal process of obtaining and verifying a complete and accurate list of each patient's current medicines. Matching the medicines the patient should be prescribed to those they are actually prescribed. Where there are discrepancies, these are discussed with the prescriber and reasons for changes to therapy are documented. When care is transferred (e.g. between wards, hospitals or home), a current and accurate list of medicines, including reasons for change is provided to the person taking over the patient's care. Points of transition that require special attention are:

Admission to hospital

Transfer from the Emergency Department to other care areas (wards, Intensive Care, or home)

Transfer from the Intensive Care Unit to the ward

From the hospital to home, residential aged care facilities or to another hospital.

The Commission is developing a range of educational materials and tools to assist hospitals introduce the process of medication reconciliation. These include a national Medication Management Plan and a user guide.

National Medication Management Plan

The national Medication Management Plan (MMP) is an initiative of the Australian Commission on Safety and Quality in Health Care (the Commission). The MMP provides health service providers with a standardised form that can be used by nursing, medical, pharmacy and allied health staff to improve the accuracy of information recorded on admission and available to the clinician responsible for therapeutic decision making.

A standardised form to record the medicines taken prior to presentation at the hospital and use for reconciling patients' medicines on admission, intra-hospital transfer and at discharge is considered essential for the medication reconciliation process. The national MMP provides Australian hospitals with a suitable form to use for this purpose The MMP form has been designed for use in adult and paediatric patients.

The MMP is based on the Medication Action Plan developed by the Safe Medication Management Unit, Queensland Health. This work was done in consultation with nurses, doctors and pharmacists. The MMP aligns with the Australian Pharmaceutical Advisory Council's Guiding principles to achieve continuity in medication management. It incorporates the minimum data set for a medication history outlined in guiding principle 4 - Accurate medication history.

National Medication Management Plan PDF version
National Medication Management Plan design files can be supplied on request.

Support materials for the National Medication Management Plan

Guide on how to complete the MMP.

Issues Register for National Medication Management Plan

The Commission maintains the Medication Management Plan (MMP).

A register of change requests, and outcomes of considerations will become available at a later date.

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World Health Organization's High 5s Medication Reconciliation Program

Sixteen Australian health services are participating in the World Health Organization's High 5s Medication Reconciliation Program. Participating hospitals will test a standard operating protocol designed to assure medication accuracy at transitions of care. It is an opportunity for participating hospitals to focus on medication reconciliation in high risk areas. They will have high visibility and recognition from implementing and evaluating the standard operating protocol, and for their leadership in standardising patient care processes.

This is a five year project. The first phase of the project is the introduction of medication reconciliation for patients 65 years of age and older who are admitted to an inpatient ward from the emergency department. In subsequent phases, the scope will be expanded to include all patients from all entry points to inpatient and outpatient settings.
The Commission is the lead technical agency for Australia's involvement in the World Health Organization program.

Assuring medication accuracy at transitions of care, through medication reconciliation, is one of the evidence based solutions for common patient safety risks which form the World Health Organization's High 5s project. Other countries participating in the medication reconciliation program include Canada, France, Germany, the Netherlands and Singapore.

The High 5s standard operating protocol for assuring medication accuracy at transitions of care is consistent with Australian practice and aligns with the former Australian Pharmaceutical Advisory Council's Guiding principles to achieve continuity in medication management.