Medication reconciliation

Medication reconciliation is a core action of the National Safety and Quality Health Service (NSQHS) Standard 4 – Medication Safety. See related information on actions 4.6.1., 4.6.2, 4.8.1, 4.12.1, 4.12.2, 4.12.3, 4.12.4.

Read more on the standards (external site).

Ensuring accurate medicine matching at transitions of care

Communication problems between settings of care or between health professionals are a frequent cause of medication errors and adverse drug events.

Unintentional changes to patients' medicine 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
  • inaccurate documentation of medication histories on patient admission to hospital.

Medication reconciliation is the 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.

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

When care is transferred (for example, 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.

Assuring medication accuracy at transitions of care through the process of medication reconciliation is one of 5 patient safety priorities nominated by the World Health Alliance on Patient Safety (external site).

Medication reconciliation is one of the 5 standards of the WA Process of Pharmaceutical Review. For further information, please see:

WA Medication History and Management Plan

The Western Australian Medication History and Management Plan (WA MMP) has been developed by the WA Medication Safety Network to meet WA Health requirements for medication reconciliation.

The WA Medication Safety Network, which is a network set up through SQuIRe Medication Reconciliation program, has been involved in reviewing medication reconciliation tools used throughout WA.

The Medication Safety Network has a representative from each WA Health site and includes:

  • regional chief pharmacists
  • regional pharmacists
  • co-ordinators of clinical services
  • senior pharmacists from tertiary and secondary sites
  • a safety and quality director
  • safety and quality project officers
  • nursing representatives.

The WA Medication History and Management Plan supports the requirements of 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.

The WA MMP is considered essential for the medication reconciliation process.

WA medication reconciliation audit tools

This spreadsheet (excel 157KB) has been developed by SCGH Medication Safety Committee. It is used to collate the medication reconciliation data and calculate the required KPIs. Instructions on how to use this tool are contained within the spreadsheet refer to tab called ‘Instruction and Info.

Guidelines for use of audit tools

Reporting Template

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 MMP is a standardised form to record the patient’s medicines taken prior to presentation at hospital. This allows the patient’s medications to be reconciled on:  

  • admission
  • intra-hospital transfer
  • discharge.

The use of the MMP is considered essential for the medication reconciliation process.

The MMP provides Australian hospitals with a suitable form that can be used by:

  • nursing
  • medical
  • pharmacy
  • allied health staff.

Together with the National Inpatient Medication Chart (NIMC), the MMP is the accurate repository for pharmaceutical information in the medical record to enabling therapeutic decision making.

The MMP was developed in consultation with all states and territories.

It aligns with the Australian Pharmaceutical Advisory Council's guiding principles to achieve continuity in medication management.

It also incorporates the minimum data set for a medication history outlined in guiding principle 4 – accurate medication history.

The MMP is designed for use in adult and paediatric patients.

The MMP is not mandatory. However, health services are strongly encouraged to implement it as a tool to enhance medication reconciliation and medication safety.

Emphasis on inter-professional use of the MMP is strongly encouraged.

MMP resources

National Medication Management Plan design files can be supplied by the Commission on request. Phone (02) 9126 3600 or email the Commission.

More information

Quality Improvement and Change Management Unit
Address: 189 Royal Street, East Perth
Phone: 9222 4080
Email: qicm@health.wa.gov.au

Produced by

Quality Improvement and Change Management Unit