2. Core Concepts and skills

2.6.4Medicines reconciliation

Medicines reconciliation is the process of identifying an accurate list of a patient’s current medicines (including over-the-counter and complementary medicines) and carrying out a comparison of these with the current list in use, recognising any discrepancies, and documenting any changes. It also takes into account the current health of the patient and any active or long-standing issues. The result is a complete list of medicines that is then accurately communicated. The pharmacist who is carrying out medicines reconciliation should ensure that any discrepancies are resolved by highlighting these and working with relevant members of the multidisciplinary team. The pharmacist should also keep the patient informed.