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



Competency Area

Patient Care


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