Continuity of Medication Management

Improving Practice

Define the Process

Prior to improving practice, it is essential that the desired medication reconciliation process is clearly defined.

Medication reconciliation can be defined as a formal four step process:

  1. Collect information to compile a list of each patient's current medications (each medication must be clearly identified and have clear directions i.e. name, dose, frequency)
  2. Confirm the accuracy of the information collected to achieve a BPMH
  3. Compare the BPMH with prescribed medicines at every transfer of care; identifying and rectifying any discrepancies
  4. Supply accurate medicines information to the patient and next care provider.


A framework has been developed to guide services in formalising medication reconciliation processes. It outlines how these processes will benefits patients, and what action is required to achieve these benefits.

Review Current Practice

Reviewing current practice will enable the project team to identify what they are doing well and recognise the areas for improvement in the process. A mapping guide has been developed to assist with this task.

A number of quality improvement tools can be used to assist with the identification and prioritisation of issues. These tools can also aid in selecting improvement strategies to address the prioritised issues. For more information on quality improvement tools go to the resources section of the CEC Clinical Practice Improvement Program .

Formalising the Process

When improving practice, some consideration must be given to determining the roles and responsibilities of each member of the health care team and the documentation requirements for each step of the process. The following guide has been developed to assist project teams with this task.

The development of a local operating procedure will also assist services define the medication reconciliation process and the specific procedure that should be applied. An example of how to document the medication reconciliation procedure has been provided.

A number of other resources and examples have been provided to assist services with improving their medication reconciliation processes