This template supports:
PCN DES targets for medicines optimisation
Safe prescribing following hospital discharge or care home transfers
Structured audit of medication changes and pharmacist interventions
Accurate completion helps improve patient safety, reduce medicines-related harm, and support contractual obligations for structured medication reviews and reconciliation.
Medication reconciliation is especially relevant:
After hospital discharge
For care home residents
During pharmacy-led reviews
Where medicines have been changed or may be non-adherent
This template ensures:
Medications are checked
Changes are recorded
Actions are coded
Reviews are attributed to the right professional
The template includes the following components:
Type of consultation:
In-person
Telephone
Failed encounter
Type of activity:
Medication requested
Review by pharmacist
Letter encounter
Audit/admin
Optimisation
Record who completed the reconciliation:
Clinical pharmacist
Pharmacist in care home
Pharmacy technician
Select:
General reconciliation
Post-discharge with patient
Post-discharge with medical notes
Record:
Date letter/discharge was scanned
Source of discharge information (e.g. hospital, specialist clinic)
Tick what happened during the review:
Medication started
Medication stopped
Medication changed
No change in medication
Include any additional comments
This template is ideal for completing structured post-discharge reconciliations within the first 7–14 days
Be sure to record who completed the reconciliation — this is essential for PCN claims
Always complete the actions section (even if no changes were made) to close the loop
Free text comments help explain rationale — particularly for discrepancies or deviations from the discharge plan
Can be linked with SMR templates or triggered after hospitalisation coding