

Anchor the baseline
Are you clear what the person was using as their usual baseline, separate from any changes made during this admission?

Start with the person’s story, not the system
Have you heard the person’s version before looking at records?

Lock in a structure
Have medicines been organised by routine (time, context, pattern)?

Flag PRN language
Did you hear “sometimes”, “only when”, or “if needed”?

Ground PRN in behaviour
Do you know how it’s used, when it was last taken, and the usual pattern?

Sweep for common omissions
Have non-tablet (inhalers, creams, patches, injections) and "natural" supplements and medicines been explicitly considered?

Look for exceptions
Is anything taken differently than prescribed or listed?

Check other evidence
Have you compared the person’s account with the best available evidence (e.g. medicine packs, pharmacy history, prior summaries, system records)?

Resolve or label uncertainty
For each medicine, is it either confirmed or clearly marked as uncertain / needing follow-up?

Clarify timelines
Is it clear what was:
used before admission
changed during admission
prescribed to continue upon discharge?

Record for handover
Could another clinician understand what you know, what you don’t, and why?

Triage risk
Are high-risk medicines resolved or clearly escalated?