Sumner Health Centre

Medication Reconcilliation Policy

Date:  03/09/2023

Review:  3 years

Purpose:

To ensure that insofar as it is reasonably practicable, the medication record of note shall be updated to reflect the medications actually being taken by the patient.

Context:

There is currently no Single Source Of Truth for a patient's medications, and in some cases these can change rapidly.

Discrepancy between what a practitioner believes a patient is taking and what is actually being taken can cause error, and reducing this potential for error is essential.

The only time discrepancy becomes an issue is when a patient asks for 'all my medication' to be repeated without consultation.  This can lead to error where the medications were changed by another provider.

Policy:

There are no practicable audits for this policy.

In order to reduce the risk of discrepancy:

1.  For all patients in care facilities with electronic or paper charting systems, the electronic or paper chart shall be the Record Of Note for prescribing.   Where we need to produce scripts (such as for controlled drugs) the medication will need to be reconciled each time a request for a prescription is issued by the dispensing pharmacy.   Where reference is needed to the list of medications currently being taken, this will be Health One.  Health One accurately reflects the medications dispensed to the patient, and this will include any prescribed by other practitioners.

2.  Upon receipt of a hospital discharge summary or specialist letter, the receiving clinician will check to see if there are changes to medication and enter these into the PMS.  Where this is done, or where not appropriate, a suitable annotation should be made in the clinical record so that it is easy to identify the reason for changes to medication at a later date.

3.  Upon consultation with a patient, it is important to inquire as to which medications are being taken.  Not all medication that is prescribed gets taken, and often the patient is the most reliable source of this information.  They can also indicate that changes have been made.  For this reason, it is ideal to require patients who have had medication changes made by a third party to consult rather than receive a prescription without consultation.

There are circumstances in which it may not be appropriate to enter a medication into the PMS -

•  Where the medication has been dispensed as a complete course, and further prescription will not be needed.
•  Where the medication is undergoing titration under the care of another prescriber, in which case the risk of recording an erroneous dose exceeds benefits.
•  Where the medication is prescribed externally by another clinician and will not ultimately be prescribed in our practice.
•  Where the medication is prescribed externally for an initial by another clinician and having it on our record will lead to a significant risk of duplicate prescribing.
•  Where another system is the Record Of Note for prescribing as duplication increases the risk of error, which exceeds any potential benefit.

Further Considerations:

It may be appropriate to repeat all the medication being taken even when only one has changed and the patient may have enough of others. 

This is most useful where the patient:

• is undergoing medication titration or changes;
• picks up medication frequently;
• has an established relationship with one pharmacy.

If this is done, the prescriber should annotate the prescription to highlight changes.   In such circumstances, consider weekly close control to reduce the risk of medication stockpiling.