Medication review template: Structured checklist for clinical practice

Key takeaways

A medication review is a structured check of every medicine a patient takes, covering safety, dose, and adherence.

The framework NICE points to sets out three types of review: prescription review, concordance review, and clinical medication review.

An NHS structured medication review is a Level 3 clinical review, delivered by a clinical pharmacist in primary care.

Patients on five or more medicines, older adults, and recently discharged patients gain the most from a yearly review.

Practice management software like Pabau keeps the form, the findings, and the recall date in one patient record.

Ask a patient to bring in every medicine they take and you rarely get a tidy list. You get a carrier bag. Expired boxes sit next to two versions of the same drug.

That bag shows the distance between the repeat prescription screen and what someone swallows each morning. Closing it is the whole point of a medication review, a structured check of every medicine for safety, dose, and adherence.

Get it right and you catch the duplicate therapy. You also catch the dose that no longer suits failing kidneys, and the tablet the patient quietly stopped in March.

What a medication review covers

A medication review is a protected consultation where a clinician works through every medicine a patient takes, one at a time. The aim is medicines optimization, which simply means every drug still has to earn its place on the list.

Clicking through a repeat prescription cannot do that work. A booked review gives you time to:

• Check what each medicine was started for, and whether it still works
• Screen for drug-drug and drug-disease interactions
• Ask about side effects and how well the patient tolerates them
• Match doses to current guidance, the patient’s age, and kidney function
• Find out what the patient really takes, and what gets in the way
• Record the findings and the changes you both agreed

That effort shows up in admissions data. Medication-related harm sits behind an estimated 5% to 10% of UK emergency presentations, and much of it is avoidable. Reviews also keep prescribing in line with current guidance, which matters when someone audits the record later.

Three levels of review, and when each one fits

The National Prescribing Centre framework, referenced in NICE’s medicines optimization guidance, sorts reviews into three types. What separates them is how deep you go, and whether the patient is in the room.

NHS England’s structured medication review, or SMR, sits at Level 3. Clinical pharmacists deliver it inside primary care networks, face to face, for patients on several long-term medicines.

That depth is what lets an SMR pick up complex interactions and adherence problems a Level 1 check would never surface.

The patients who need one most

Not everyone needs a formal review every year. These groups do:

• Polypharmacy patients: five or more regular medicines. Interaction risk climbs with every addition, and duplicate therapy hides easily on a long list.
• Older adults: over 65, especially with reduced kidney or liver function. A dose that suited someone at 60 may not suit them at 80.
• Chronic conditions: diabetes, hypertension, heart failure, COPD, and mental health conditions all shift over time, and the prescribing has to shift with them.
• Recently discharged patients: discharge lists pick up duplicates and drugs nobody stopped. A review 2 to 4 weeks after discharge reduces readmissions.
• Known adherence problems: a shared review finds the barrier faster than another reminder letter ever will.
• Unexplained symptoms: dizziness, falls, and fatigue often trace back to a drug rather than a new diagnosis.

Beyond those groups, prioritize anyone on a high-risk medicine such as an anticoagulant, an NSAID, or an ACE inhibitor. NHS England’s SMR guidance sets out the full eligibility criteria.

How the appointment runs, start to finish

The workflow below maps onto the template section by section, so the form fills itself as you move through it.

1. Find the patient. Reporting on your patient records flags who is due, usually by medicine count, age, or drug class.
2. Send the invite. Ask the patient to bring every box, inhaler, and patch, plus a medication log if they keep one.
3. Prepare. Pull the current list, indications, recent hospital letters, kidney and liver results, and allergy status. A completed history and physical form saves time here.
4. Consult. Allow 30 to 45 minutes, face to face or by video, and work through each medicine with the patient.
5. Assess. Check interactions, doses, duplication, and anything worth stopping, against current guidance.
6. Agree changes. Write down what you both decided, and hand the patient a copy before they leave.
7. Follow up and record. Book the next contact, tell the GP what changed, and file the review with a full audit trail.

Step two is where most reviews fall over. If the patient arrives without their boxes, you are reviewing the repeat screen rather than their medicines. A phone call the day before fixes that far more reliably than a letter.

What belongs on the form

A complete record holds the clinical detail and the audit trail in one place. Capture all of the following:

• Patient identifier and date of birth
• Date of the review, how long it took, and who ran it
• Every regular and as-needed medicine, with doses and frequencies
• Why each medicine was started, and whether it still works
• The interaction check, naming the reference source and the date
• Side effects reported or observed, and their effect on adherence
• What the patient really takes, and what gets in the way
• Dose safety against age, weight, and kidney or liver function
• Anything worth stopping, with the reasoning written down
• Changes agreed with the patient, plus the education you gave
• Follow-up date and any urgent action for the GP

The free form above covers the clinical sections. Demographics, the interaction check, and the audit trail come from your own record system, so the two work together rather than duplicating each other.

The checks to make before you sign off

Run these nine checks before you close the record. They take a couple of minutes and catch most of what a later audit would flag.

• Interactions: cross-check every concurrent medicine against the BNF or a current interaction checker, then note the severity.
• Duplicates: two drugs from the same class, often started by different prescribers months apart.
• Contraindications: allergies, kidney or liver impairment, age, and any diagnosis added since the last review.
• Side effect burden: ask how the medicines make the patient feel, then listen for symptoms that match known effects.
• Adherence barriers: cost, timing, packaging, or a side effect the patient never thought to mention.
• Dose appropriateness: check against age, weight, and kidney function using a current reference.
• Monitoring due: bloods, INR, or drug levels that should have been taken and were not.
• Deprescribing candidates: anything left on the list with no clear indication behind it.
• Next review date: 12 months for stable patients, sooner after any change you made today.

How often to repeat it

Once a year for most patients on long-term medicines, and sooner after any change. Annual reviews suit patients over 65, anyone on five or more medicines, and anyone taking a high-risk drug.

After a dose change or a new prescription, bring the next contact forward to somewhere between 4 and 12 weeks. The point is to see whether the change did what you hoped before it becomes permanent.

Honestly, the recall is harder than the review. GP practice software that flags the due cohort and sends the invite keeps the list moving. Otherwise someone ends up auditing it by hand each quarter.

The same discipline applies well outside primary care. HRT clinics review at three months and then yearly, while weight management services check dose and tolerance far more often than that.

Polypharmacy is where the risk stacks up

Five or more regular medicines is the point at which risk starts to compound. Every extra drug adds interaction risk, side effect burden, and one more thing for the patient to remember at breakfast.

NICE prioritizes these patients for review, especially where the list carries a high-risk medicine. Those medicines bring their own monitoring:

• Anticoagulants: INR for warfarin, kidney function for DOACs, plus a bleeding risk check.
• NSAIDs: kidney function, stomach protection, and cardiovascular risk.
• ACE inhibitors and ARBs: kidney function and potassium, with a dose change if eGFR falls.
• Diuretics: electrolytes, kidney function, and a quick check for dizziness on standing.
• Corticosteroids: bone density, infection risk, and a written plan to reduce the dose.
• Insulin and sulfonylureas: hypo history, and whether a hypoglycemia care plan is in place.

What good documentation looks like

Write it so another clinician can open the record in six months and see what you decided, and why. That single test covers most of what governance and audit ask for.

• Date, duration, and the name of the clinician who ran the review
• The full medicine list exactly as it stood on the day
• Assessment findings: interactions, side effects, adherence, and dose conclusions
• What the patient wanted, and what the two of you discussed
• Every change, with the reasoning sitting next to it
• Follow-up date, safety alerts for the GP, and any tests to book
• A timestamped audit trail carrying your authentication

For NHS SMR reporting, structured data goes to the local primary care network portal. A consistent medical notes template keeps the review beside the rest of the record, which is what makes that export straightforward.

Five mistakes that show up in audits

• Recording “reviewed, no change” with nothing to show what was checked
• Leaving a stopped medicine on the repeat list, so it reappears at the next request
• Documenting the interaction check without naming the source or the date
• Writing the plan in free text only, so the recall date never reaches the appointment book
• Losing the patient’s own words about why they skip a dose

How Pabau supports medication reviews at scale

In a lot of practices this process runs across three systems. The recall list sits in a spreadsheet, the form is a Word document, and the findings get typed into the record afterwards from handwritten notes.

Practice management software like Pabau holds all three in one place. Digital forms capture the medicine list, side effects, and adherence answers straight into the patient record, so nothing gets retyped. Automated workflows handle the recall and the invite.

Pabau Scribe, our AI scribe, turns the consultation into a structured note while you talk. The write-up is finished before the patient reaches the door.

What you get from that is a higher completion rate and a record that survives an audit. Every entry is timestamped, attributed, and locked, and the reporting tools show you who is still waiting on a review.

Run medication reviews without the paper trail

Pabau keeps the recall list, the review form, and the follow-up date in one patient record. Your team spends the appointment on the medicines, not on retyping notes afterwards.

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Conclusion

The form is the easy part. What decides whether reviews work is whether the recall list keeps moving, and whether the next clinician can read what you decided.

So start with the recall rather than the paperwork. Pick one cohort, patients on five or more medicines, and get them booked in. The checklist holds up perfectly well once the appointments exist.

Keeping that whole loop in one system is what makes it sustainable past the first month. Book a demo to see how Pabau handles the recall, the form, and the audit trail for medication reviews.

Continue your research

Need to record the review over time? Clinical progress notes template gives you a consistent structure for tracking how a patient responds between appointments.

Reviewing psychotropic prescribing? Psychiatric evaluation template covers the assessment detail that sits behind a mental health medication decision.

Tracking medicines across a shift? Nurse brain sheet keeps doses, times, and observations in one place during a busy ward round.

Monitoring anti-epileptic drugs? Seizures nursing care plan sets out the monitoring and safety steps that go alongside long-term seizure medication.

Adjusting diabetes medication? Hyperglycemia nursing care plan shows the escalation steps to document when blood glucose stays high despite treatment.

Frequently asked questions