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Medication reconciliation

Medication reconciliation means that the medicines the patient should be prescribed match those that are prescribed. Transition points of care are particularly prone to unintended changes in medication regimes and other medication errors.

Medicine lists at transitions of care

When a patient’s care is transferred to another clinician, a current and accurate list of medicines, including reasons for change, is given to that clinician. Some transition points are more prone to error and require special attention, such as:

  • Admission to hospital
  • Transfer from the emergency department to other care areas (wards, intensive care, home)
  • Transfer from the intensive care unit to the ward
  • From the hospital to home, aged care home or another hospital.

Reducing the opportunity for medication errors

Unintentional changes to patients’ medicine regimens often happen during hospital admissions, and can cause patient harm during a hospital stay or after discharge:

  • Between 10% and 67% of medication histories have at least one error, and up to 33% of these errors have the potential to cause patient harm
  • More than 50% of medication errors occur at transitions of care
  • Patients with one or more medicines missing from their discharge information are 2.3 times more likely to be readmitted to hospital than those with correct information on discharge
  • 85% of discrepancies in medication treatment originate from poor medication history taking.

Matching up medicines can help ensure continuity of care, and prevent harm by reducing the opportunity for medication errors.

Related pages

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Resources to support medication reconciliation include:

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