The importance of medication reconciliation for patients and practitioners

Author's comments Margaret Duguid, author of the article, comments: I would like to thank Dr Ramanathan for highlighting the risks of medication-related problems occurring following discharge from hospital and the value of hospital and community liaison services and home medicines reviews in the immediate discharge period. Home medicines reviews within 7–10 days of discharge have been shown to decrease the potential for adverse events in at-risk patients discharged home.2 To date, timely access to home medicines reviews in the immediate discharge period has been a limitation to their uptake.3 However, with the ability for general practitioners to refer directly to accredited pharmacists and the proposed hospital home medicines review referral pathway (due to be introduced in late 2012), some of the barriers to early post-discharge medication reviews will be removed. Patients transferred from hospital to residential aged-care facilities are at particular risk of medication errors. Often their medicines are changed and doses of newly prescribed medicines omitted or delayed. In the case of a resident returning from a hospital admission, ceased medicines were inadvertently administered from a pre-existing medication chart.4 Checking the medication orders against the medicines list in the discharge summary to identify any discrepancies is an important safety practice. As Dr Ramanathan pointed out, medication reviews early in the admission provide the opportunity to identify and reconcile these discrepancies as well as review those medicines commonly known to cause harm in older patients. Pharmacists also have an important role in checking the patient’s records when new medicines are ordered, ceased or changed and reconciling any discrepancies with the prescriber. The Australian Commission on Safety and Quality in Health Care has a strong commitment to patient safety. Promoting medication reconciliation is one of its priorities.