Medication review

Medication review is a systematic assessment of a patient's medication management with the aim of optimising the quality use of medicines and minimising medication-related problems.

It is a multidisciplinary responsibility that ensures the ongoing safe and effective use of medicines at all stages of the medication management pathway.1,2

Medication Order Review

A review of individual medication orders and / or prescription validity. It may take place without the patient present.

Medication Adherence Review

A review of a patient's medicine taking behaviour (how they actually take their medicines and what their beliefs about medicines are).

Clinical Medication Review

A comprehensive review of a patient's medicines in the context of their clinical conditions. It considers the management of the conditions being treated and the appropriateness and continuing need of each medication, as well as potential gaps in therapy. Partnering with the patient/carer is essential when undertaking a clinical medication review.

Medication Review and Medication Reconciliation are distinct but interrelated processes.

Medication review involves an evaluation of a patient’s medicines with the aim of optimising the quality use of medicines. A medication review will often result in the identification of actual or potential medication-related problems and recommendations to optimise medicines use.

Medication Reconciliation involves ensuring accurate and complete medicines information is communicated at all transfers of care. Medication reconciliation will often result in identification of medication discrepancies (e.g. differences between the documented medication history and the admission medication orders) which may be intentional or unintentional. Visit the Medication Reconciliation page for more information.

Why is medication review important?

Conducting evidence-based medication reviews can optimise the medications used and reduce medicine-related problems.

The Australian Commission on Safety and Quality in Health Care's (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards (second edition) require health service organisations to have processes:

  1. To perform medication reviews for patients, in line with evidence and best practice.
  2. To prioritise medication reviews, based on a patient's clinical needs and minimising the risk of medication-related problems.
  3. That specify the requirements for documentation of medication reviews, including actions taken as a result.1

How to conduct a Medication Review?

Medication review is a multidisciplinary responsibility which ensures the ongoing safe and effective use of medicines at all stages of the medication management pathway.

The delivery models for medication review may vary across health service organisations. Patients with a higher risk of experiencing medication-related harm should be given priority.1,2 Risk assessment and stratification should be based on evidence and local organisational priorities.3

A Guide to Medication Reviews for NSW Health Services 2019

In partnership with the Medication Review Working Group, a subgroup of the Continuity of Medication Management Expert Advisory Group (CMMEAG), the CEC has developed a Guide to Medication Reviews as a resource for health service organisations and clinicians to develop systems and processes to conduct medication reviews for patients.

A Guide to Medication Reviews for NSW Health Services 2019

Download PDF ~66KB

The guide specifically supports action 4.10a of the NSQHS Standards by providing advice on evidence and what constitutes best practice when performing medication reviews.

The guide encourages health service organisations to consider:

  • the purpose of medication review
  • the importance of partnering with patients, carers and their families
  • roles, responsibilities and training requirement of clinicians
  • development of a consistent and effective method for performing medication reviews, including how it can be built into existing work practices and how it relates to other medication management processes such as medication reconciliation.

With the majority of NSW Health services utilising electronic medication management systems, the development of electronic tools to assist with risk stratification as well as documentation and monitoring requirements for medication review and other medication management processes have become possible. The CEC is committed to working towards safe, user friendly electronic solutions to meet the needs of health services.

Polypharmacy review

Inappropriate polypharmacy in older people is common and contributes substantially to adverse drug events, drug-drug interactions, medication non-adherence and reduced functional capacity.4

Translational research projects funded by NSW Health and Sydney Health Partners, led by Prof Sarah Hilmer from Northern Sydney LHD, with associate investigators from Sydney LHD, NSW Therapeutic Advisory Group (TAG), the University of Sydney and Macquarie University, developed and piloted a polypharmacy intervention bundle to facilitate review of polypharmacy in routine care.

The HETI module (course code: 183595643) is suitable for all clinical staff involved in the care of older inpatients. It provides information and tools to review polypharmacy, prioritisation of patient review and resources for deprescribing.

The Resource kit for Measuring Strategies to Reduce Harm from Polypharmacy in Australian Hospitals contains Quality Use of Medicines (QUM) indicators, Patient Reported Experience Measures (PREMs) and Risk Stratification Tools.

It has been designed to provide a set of tools to evaluate processes involved in identification of medication-related harm in older hospitalised patients and the management of inappropriate polypharmacy. The PREMs evaluate patients' experiences in the decision-making process of deprescribing in hospital.

There are several deprescribing guides and consumer leaflets available. The Deprescribing Guides support clinicians in deprescribing. The Consumer Information Leaflets support communication of deprescribing decisions to patients and/or carers.

  1. Australian Commission on Safety and Quality in Health Care. (2017).National Safety and Quality Health Service Standards Guide for Hospitals.Sydney: ACSQHC.
  2. Clyne, W., Blenkinsopp, A. and Seal R. (2008).A Guide to Medication Review. [online] Liverpool, UK: National Prescribing Centre. Available at: [Accessed 26 Feb. 2020].
  3. Society of Hospital Pharmacists of Australia. (2015). Risk Factors for Medication-Related Problems: fact sheet. Melbourne: SHPA.
  4. Maher RL, Hanlon J, Hajjar ER. (2013). Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf13(1):57–65. 10.1517/14740338.2013.827660