Synopsis
Prescribe and review medicines safely by confirming indication, benefit, patient use, monitoring, interactions and continued need across transitions of care.
- Before prescribing, confirm identity, indication, allergies, pregnancy potential, relevant organ function, current medicines and enough clinical information for the decision.
- Use the current BNF, SmPC and condition guideline for exact dose, route, frequency, duration, contraindications and monitoring; separate licensed product information from national recommendation.
- A structured medication review is a shared, critical examination of all medicines to agree treatment, optimise benefit, minimise problems and reduce waste.
Reasoning priorities
Establish actual current exposure and discrepancies.
Triangulate patient account, containers, repeat list, dispensing and clinical letters and resolve rather than merely list differences.
Worked reasoning
A patient requests repeats after admission; the discharge list stops one medicine, halves another and adds a seven-day item, but old repeats remain active.
- Confirm what the patient has actually taken since discharge, current symptoms and urgent harm; compare hospital list, pre-admission record, pharmacy supply and available results.
- For every discrepancy establish whether change was intentional, why, duration, monitoring and responsible clinician; contact the hospital team when the rationale or safety is unclear.
- Complete the final action by updating active repeats, issuing only verified necessary supply, documenting reasons and communicating the reconciled list to patient, pharmacy and relevant care providers.
- Verify understanding with teach-back, arrange medicine-specific monitoring and expiry of the time-limited item, and review for disease control, adverse effects and unresolved specialist responsibility.