Hei Hei Health Centre
Medication Reconcilliation Policy
Date: 25/07/2025
Introduction:
With the advent of electronic record sharing across Health Care Practitioners (HCP), it has become increasingly important to ensure that the medications documented by the primary custodians of the patient record reflect those actually being taken by the patient.
Patient medications may change when:
Patients have contact with an HCP either in or out of the practice;
Patients choose to cease or start medication on their own;
Supply issues constrain the availability of medications.
When we become aware of changes, they should generally be documented in the medication section of the PMS. This should be done within 10 working days of receipt of change notification.
Audit:
It is not practicable to audit the reconciliation of medication because there is no simple way to identify cases where an event has not happened. Instead it is beholden on each HCP to behave responsibly and keep to the practice policy.
Training:
Staff induction
Data Standards Policy
Quality Improvement:
Any issues with a reconciliation or suggestions on improvement on the policy should be raised with the Clinical Director as soon as possible.
Policy:
HCP becoming aware of a change in patient medication should ensure that the medication section of the PMS reflects the change; or otherwise that a reason for not doing so is documented in the notes.
Upon reviewing medication:
When reviewing medication for repeat prescribing, whether or not the patient is present:
Ensure that the prescription meets the data standards, including ensuring that an appropriate classification is entered for each long-term medication; and
Remove the long-term flag from any medications no longer being taken, or which are obviously obsolete due to long elapsed time since the last prescription.
Notification of medication cessation:
remove the long term flag from the medication to be stopped; and
document in the notes the reason for the change.
Eg: STOPPED metformin per diabetes clinic letter of ddmmyyyy
Notification of dose change:
remove the long term flag from the medication to be changed; and
add the new medication to the chart and mark it long term; and
DO NOT mark the medication as ‘prescribed externally’; and
document in the notes the reason for the change.
Eg: Dose of Metoprolol increased to 47.5mg per cardiology clinic letter of ddmmyyyy.
The reason for not using the ‘prescribed externally’ flag is that this is unhelpful – it is not shared outside the practice, but it draws undue attention to the medication by marking it as bold face.
Notification of new medication:
Add the new medication to the chart and mark it long term; and
DO NOT mark the medication as ‘prescribed externally’; and
document in the notes the reason for the change.
Eg: Doxazosin added per Urology clinic letter of ddmmyyyy.
It should be clear from all the above that the key is both changing the medication in the list of medications AND documentation in the notes.
Exceptions:
It is NOT appropriate to document medication that will never be prescribed from our practice such as short courses of medications prescribed elsewhere, or other than in exceptional circumstances, medication only prescribed by other practitioners. Doing so does not add useful information to the shared record and potentially increases the risk of erroneous prescribing, for instance when ‘all my medications’ are requested for repeat.
It is also appropriate to ensure that medications have been appropriately authorised before adding them to the list – it may be insufficient to take a patient’s word for the change for instance – always check on Health One if there may be any doubt, but especially in the case of the prescription of potentially harmful or diverted medications.
It MAY be appropriate to delay reconciliation such as in cases where the patient is expected to be seen soon, and particularly where the medication is undergoing dose titration and the final dose may be uncertain. In such cases, the choice NOT to reconcile medication should be documented in the notes eg:
Noted addition of allopurinol. NOT reconciled because rheumatology are titrating.
Change Log: