Medication Reconciliation in Pharmacy Support
Create the most accurate list possible of all medications consumed by a patient to ensure accurate and complete medication information transfer during transitions of care
Type
Domain
Competency Area
Patient Care
Levels
Assist with physical medication reconciliation
Inspect patients’ medicine containers to ensure that the drugs in the containers are not defective, have not expired and match the labels
Report to supervisors on abnormal conditions of drugs
Repackage drugs
Count physical numbers of each medication
Document the name, strength, and quantity of medications
Determine drug identity, accuracy of labelling instructions, expiry date, storage condition and suitability of use of patients’ medications
Perform proper relabelling of drugs with updated administration instructions
Assist with system medication reconciliation
Obtain best possible medication history (bpmh)
Review medicine lists
Retrieve patients’ medical records
Recognise initial sources of information
Highlight to pharmacists on drug duplications and omissions
Recognise situations where other sources of information including general practitioners (GPs), nursing homes, dialysis centres are needed and contact them
Perform medication reconciliation
Recognise situations where verification with patients or caregivers is necessary and contact them to clarify
Verify patients’ physical medication supply
Compare medication history obtained with medicines ordered
Identify changes in medication regimens
Identify discrepancies during interviews and refer to pharmacists for further review
Recognise potential medication errors that may occur if discrepancies are unintentional and the urgency to rectify such discrepancies
Document medication reconciliation performed in a structured format using terminology that is consistent and comprehensible by other staff
Conduct patient interviews independently
Adapt to patients’ needs during medication reconciliation
Propose solutions or recommendations for the medications that required reconciliation
Review discrepancies and detected errors to ascertain if they are actionable by pharmacists