SHPA Standards of Practice for the Provision of Medication Reconciliation

Abstract

These are standards of professional practice and not standards prepared or endorsed by Standards Australia. They are not legally binding.

Letters to the Editor

“…6 The practicality of this goal is far from realistic as it relies on having a fully staffed pharmacy department. It is imperative to highlight that these standards describe a 'best practice' model of service.…”

Embedding the clinician-researcher pharmacist in healthcare

“…230,231 To ensure that a complete and accurate list of medicines is taken prior to presentation to hospital, confirmation with a second source is recommended. 230,232 When this was discussed with those responsible, it was found that this procedure had been followed (confirmation with two sources), but not documented. 233 This puts documentation as an area to target.…”

“…Medication reconciliation ensures that the patient receives all intended medicines and reduces common errors of transcription, omission, duplication, medicinemedicine and medicine-disease interactions. 80,230,232,234 Medication reconciliation is a process that needs to be documented within our service and is done by the pharmacist when a patient is reviewed. There is currently a clinical pharmacist based on the ward who is able to perform reconciliation.…”

“…101,176,230 Whilst practicing, a pharmacist is autonomous and their work is rarely evaluated or bench-marked against peers, although it is something that the profession is trying to implement. 276 This leads to the development of ad hoc practice and individual methods.…”

“…234,304 Often medicine-related problems are due to miscommunication regarding the continuation/discontinuation of medications on a patient's admission to, or discharge from, hospital. 101,230,291,311 More than 50% of medication errors occur at transitions of care, and up to one third of these errors have the potential to cause harm. 233,312 Omitting one or more medicines from a patient's discharge summary exposes patients to 2.31 times the usual risk of re-admission to hospital.…”