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Medication History Session 3: Discharge Reconciliation Interview

1. Aim

To practise year 4 medication history 3 of 3 using an assumed scenario or approved de-identified case. Actual completion must be entered in the student record.

2. Requirements

Supervisor-approved teaching case or consented de-identified patient record, local clinical references, observation sheet, verified laboratory or medicine data, privacy safeguards, and preceptor feedback. Actual patient details, doses, reference intervals, software, and outcomes must be entered in the student record.

3. Theory

At discharge, the current intended regimen should be compared with the admission list and inpatient changes. The student should ask about access, understanding, and recently stopped medicines. A discrepancy may be intentional, so the prescriber or pharmacist must verify it.

4. Procedure

1. Confirm the syllabus requirement, case status, consent and privacy safeguards, and preceptor.
2. Record verified facts separately from assumed role-play inputs; identify missing information.
3. Complete the supervised observation, interview, or case review: Review an assumed discharge list with a role-play patient. Compare add, stop, and change decisions with source documentation, then rehearse a supervised clarification and teach-back.
4. Check source records, units, timing, and any discrepancy with the preceptor.
5. Document only supported interpretation; do not make a patient-specific recommendation without qualified clinical review.
6. Record feedback and whether a real supervised session or presentation was completed.

5. Observation and calculation

Assumed teaching scenario only: An assumed discharge list changes an assumed medicine schedule without a documented reason. This invented example calls for verification, not a student-made correction. Every invented input and observation is assumed, not a real patient record or completed clinical session.

6. Output or final result

Submit a labelled discharge reconciliation and preceptor-reviewed conclusion. Actual patient result and required session completion: Record here.

Teaching-lab safety: Protect patient confidentiality and use consent and clinical supervision. Do not write assumed data in a real chart or act on a simulated recommendation.

This page is a supervised-activity guide; it does not report a completed case.

7. Sources

• PharmacoLearn Pharm.D Year 4 syllabus
• PCI Pharm.D Regulations and Syllabus
• PharmacoLearn syllabus
• Primary professional guidance

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Theory notes: Pharm D Year 4, 4.3 Clinical Pharmacy