Synopsis
Reconstruct actual medicine use across transitions, resolve discrepancies by clinical priority and respond to prescribing or administration errors before further harm occurs.
- Reconciliation compares actual pre-admission treatment with current orders and resolves the differences; transcription alone is insufficient.
- Use the patient’s account and other reliable sources, including dispensing and administration records when needed.
- Identify time-critical medicines immediately; do not wait for the full medicine history before preventing a harmful omission.
Key red flags
Daily administration of methotrexate intended for weekly autoimmune treatment is a potentially fatal overdose: stop further doses and obtain urgent hospital and toxicology advice even if symptoms are absent.
Reasoning priorities
Reconstruct the intended regimen and the patient’s actual use.
Ask the patient or a knowledgeable carer, then compare reliable records appropriate to the situation. Include dose, formulation, route, usual times, indications and last doses. Explain discrepancies respectfully: patients may have made deliberate adjustments because of side effects that never reached the repeat-prescribing record.
Worked reasoning
A woman admitted with a fracture usually takes methotrexate 15 mg orally each Friday for rheumatoid arthritis. Her medicine card and community pharmacy confirm this. The admission chart says 15 mg daily, and no hospital doses have yet been given.
- Compare the current order with the verified indication and schedule. The daily frequency is inconsistent with this patient’s established weekly autoimmune regimen and creates an imminent overdose risk. Stop the incorrect order before the next administration round.
- Confirm the last home dose and inspect the administration record to establish whether exposure occurred. In this case no hospital dose has been given; if uncertainty remains, treat the exposure history as unresolved and obtain urgent advice rather than assuming interception was complete.
- Ask the responsible prescriber to enter the correct weekly instruction with the day written in full, after assessing whether acute illness or the admission itself requires temporary withholding. Reconciliation confirms the baseline regimen; it does not automatically authorise continuation in every new clinical circumstance.
- Explain the discrepancy and corrected plan to the patient and nursing team. Verify the tablet strength and ensure that the discontinued daily order cannot remain active elsewhere in the electronic system or on a paper chart.
- Check the next scheduled administration and report the intercepted error through the local learning process. Investigate how the daily frequency was selected and whether defaults or order-set design could expose other patients to the same mistake.