Medication reconciliation

Medication reconciliation is a core action of the National Safety and Quality Health Service (NSQHS) Standard 4 – Medication Safety. See related information on actions 4.5, 4.6, .4.7, 4.10, 4.11, 4.12, 4.15.

Read more on the standards (external site).

Ensuring accurate medicine matching at transitions of care

Communication problems between settings of care or between health professionals are a frequent cause of medication errors and adverse drug events.

Unintentional changes to patients' medicine regimens often happen during hospital admissions.

These unintended changes can cause serious problems during a hospital stay or when patients are discharged.

The process of medication reconciliation has been shown to reduce errors and adverse events associated with:

  • poor quality information at transfer of care
  • inaccurate documentation of medication histories on patient admission to hospital.

Medication reconciliation is the formal process of obtaining and verifying a complete and accurate list of each patient's current medicines, matching the medicines the patient should be prescribed to those they are actually prescribed.

Any discrepancies are discussed with the prescriber and reasons for changes to therapy then documented.

When care is transferred (for example, between wards, hospitals or home), a current and accurate list of medicines, including reasons for change, is provided to the person taking over the patient's care.

Points of transition that require special attention are:

  • admission to hospital
  • transfer from the emergency department to other care areas (wards, intensive care, or home)
  • transfer from the intensive care unit to the ward
  • from the hospital to home, residential aged care facilities or to another hospital.

Medication reconciliation on admission and discharge are two of the four standards of medication review as articulated in the Medication Review Policy MP 0104/19.

WA Medication History and Management Plan

The Western Australian Medication History and Management Plan (WA MMP) has been developed by the Change to WA Medication Safety Collaborative (WA MSC) to meet WA Health requirements for medication reconciliation.

The Change to WA Medication Safety Collaborative (WA MSC) has a representative from each WA Health site and includes:

  • regional chief pharmacists
  • regional pharmacists
  • co-ordinators of clinical services
  • senior pharmacists from tertiary and secondary sites
  • a safety and quality director
  • safety and quality project officers
  • nursing representatives.

The WA Medication History and Management Plan supports the requirements of the Medication Review Policy MP 0104/19 to achieve continuity in medication management.

The WA MMP is considered essential for the medication reconciliation process.

WA medication reconciliation audit tools

Guidelines for use of audit tools

Reporting Template

More information

Medicines and Technology Unit
Address: 189 Royal Street, East Perth
Phone: 9222 4080


Last reviewed: 22-12-2022