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Medicines reconciliation means making one accurate list of every medicine you take, including ones you buy and herbal remedies, and checking it against what the hospital thinks you take. It should happen before cancer treatment starts, when you go into hospital, when you move wards and when you go home.
NICE NG5 (2015) uses the Institute for Healthcare Improvement's definition: identify an accurate list of a person's current medicines, compare it with the list in use, recognise and document discrepancies, and communicate the result; 'medicines' includes over-the-counter and complementary products. In an acute setting reconciliation should be done within 24 hours of a move between settings, or sooner if clinically necessary, may need repeating on admission, transfer and discharge, and should be done in primary care within a week of the practice receiving discharge information. It should be done by a trained, competent professional, ideally a pharmacist, pharmacy technician, nurse or doctor, and involve the patient and family.
Cancer-specific standards add the anticancer start point. ASCO-ONS (2024) requires the medication list, with over-the-counter medicines, herbal products and supplements, to be updated at every encounter and reviewed when it changes; BOPA (2025) puts the drug history and interaction check into the pharmacist's verification of the first cycle. Practice lags: across 21 Canadian cancer centres most collected a best possible medication history but full reconciliation was uncommon, and one centre's improvement project reached a documented history in 26.6% of patients starting systemic therapy and full reconciliation in 4.7%. Where it is done, it finds things: before early-phase trials, pharmacist reconciliation in 501 patients uncovered 35% of the medicines patients were taking and 51% of prohibited or monitored drugs that oncologists had missed.
Why: Medicines are most often lost, doubled or changed by mistake when people move between settings.
“1.3.1 In an acute setting, accurately list all of the person's medicines (including prescribed, over‑the‑counter and complementary medicines) and carry out medicines reconciliation within 24 hours or sooner if clinically necessary, when the person moves from one care setting to another – for example, if they are admitted to hospital.”
Why: A list only helps if the differences between it and the prescription chart are found and settled.
“Medicines reconciliation, as defined by the Institute for Healthcare Improvement, is the process of identifying an accurate list of a person's current medicines and comparing them with the current list in use, recognising any discrepancies, and documenting any changes, thereby resulting in a complete list of medicines, accurately communicated.”
Why: They know what is actually taken, including things bought without a prescription.
“1.3.6 Involve patients and their family members or carers, where appropriate, in the medicines reconciliation process.”
Why: Previous treatment and current medicines can change which regimen is safe and what dose is right.
“Check for potential interactions, contra-indications and duplication between all planned SACT & supportive medication and patient’s concurrent medication.”
Why: People with cancer see many specialists, and medicines change often during treatment.
“The patient's medication list inclusive of prescribed and over-the-counter medications, herbal products, and supplements is updated and documented in the medical record at every encounter and reviewed by a licensed practitioner when a change occurs”
Why: Each handover is a new chance for a medicine to be stopped or restarted by mistake.
“1.3.2 Recognise that medicines reconciliation may need to be carried out on more than one occasion during a hospital stay – for example, when the person is admitted, transferred between wards or discharged.”
Why: Medicines paused in hospital are often never restarted unless someone plans it.
“If medications are discontinued during an acute illness, communicate a clear plan of when to restart the discontinued medications to the affected person and healthcare providers, and ensure documentation in the medical record.”
KDIGO (Kidney International) 2024 · Practice Point 4.3.2
Why: The GP, community pharmacy or next hospital team needs to know what changed and why.
“1.2.2 For all care settings, health and social care practitioners should proactively share complete and accurate information about medicines: ideally within 24 hours of the person being transferred, to ensure that patient safety is not compromised and in the most effective and secure way, such as by secure electronic communication, recognising that more than one approach may be needed.”
Why: Discharge changes, such as a new anticoagulant or a stopped medicine, have to reach the GP record.
“1.3.3 In primary care, carry out medicines reconciliation for all people who have been discharged from hospital or another care setting.”
How care is usually carried out, read from the guidelines and standards cited. Your own team's protocol and their judgement come first; this page is for understanding it, not for doing it yourself.
NICE NG5 (2015) sets the process and the clocks for every setting: a full list including over-the-counter and complementary medicines, reconciled within 24 hours of a move into an acute setting, repeated at transfer and discharge, done by a trained professional with the patient, and completed in primary care within a week of discharge information. For cancer treatment, ASCO-ONS (2024) adds a list updated at every encounter, and BOPA (2025) a drug history and interaction check in the first-cycle verification. None of these is graded.
NICE 2015 · ASCO and ONS (JCO Oncology Practice) 2024 · British Oncology Pharmacy Association 2025
Where it differs: A pharmacist reconciles medicines against each trial's prohibited and monitored lists before a patient starts an investigational drug.
Evidence: In 501 patients at one French centre it uncovered 35% of the medicines patients were taking, found 158 prohibited interactions (more than half with herbal products) and caught 51% of prohibited or monitored drugs missed by oncologists (Malifarge 2024).
Where it differs: Collects a structured best possible medication history for people starting systemic therapy, with full reconciliation as a later step.
Evidence: 81% of 21 Canadian cancer centres had a process for the history but full reconciliation was uncommon; one centre's improvement project reached 26.6% documented histories and 4.7% full reconciliations within 30 days of starting treatment (Powis 2023).
Shares Oral anticancer medicines at home: prescribing, teaching, adherence, storage, handling and disposal, Anticancer treatment prescribing and pharmacy verification before each cycle.
Shares Oral anticancer medicines at home: prescribing, teaching, adherence, storage, handling and disposal, Anticancer treatment prescribing and pharmacy verification before each cycle.