An introduction to Medicines Reconciliation: a guide to implementation

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An introduction toMedicines Reconciliation a
guide to implementation

• 29th February 2008
• Hinckley Island Hotel

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Objectives of this session

• To take you through the basic principles of
  medicines reconciliation as included in the guide
• To highlight some of the main features,
  including
• The benefits of medicines reconciliation
• The role of medication history taking
• The use of a minimum dataset
• Sources of information for medicines
  reconciliation
• Responsibility for medicines reconciliation
• Impact assessment and process measures
• To identify the key skills required to carry out
  medicines reconciliation

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Basic principles

• Transferring patient care should be assessed and
  managed with regard to medicines
• This includes any care transfer
• Accurate, reliable, and timely information is
  required
• Document any changes, discrepancies, deletions,
  and additions to medicines regimes
• Focus on getting it Right! Right! Right!

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The benefits

• Reduction in risk of medication errors and near
  misses
• Better communication
• Greater patient involvement
• Potential reduction in waste
• Reduction in duplicated effort
• Improved record keeping
• Increase in timely availability of information
• Potential avoidance of medicines-related
  admissions
• Increase potential to integrate services
• Development of local standards and procedures

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Who benefits?

• General Practitioners
• Hospital Doctors
• Non-medical prescribers
• Ward-based clinical pharmacists and technicians
• Community pharmacists
• Nurses and other care-givers
• Organisations and Trusts

The patient!
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Medication History Taking

• An essential first stage of medicines
  reconciliation
• Involves the collection and accurate
  identification of a patients current list of
  medicines
• Typically undertaken in secondary care following
  admission to hospital
• Can include medication history taking in other
  settings

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Minimum datasets
e.g. on admission to hospital from primary care

• Complete patient details
• Admitting condition plus co-morbidities
• Complete list of all medicines currently
  prescribed for the patient (remember OTC)
• Dose, frequency, formulation route
• Indication of short term use only medicines
• Known allergies and history of interactions

Plus local agreement
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Sources of information

• Recent print-out from GP computer system
• Repeat prescription tear-off sheets
• Patients own drugs (PODs)
• Patients and carers themselves
• Previous hospital notes

Reliability!
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Responsibility
1) Personal responsibility of

• Professional responsible for the patients
  transfer of care
• Person receiving the patient into their care
• The patient and/or carer involved
• Other people involved in the process

Where does your responsibility lie?
2) Professional responsibility
3) Corporate responsibility
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Impact assessment and process measures
Procedural measures

• E.g. The healthcare organisation has written
  policies and procedures for medicines
  reconciliation on admission to hospital
• E.g. The percentage of patients that have had
  their medicines reconciled within 24hrs of
  admission
• E.g. The number of medication discrepancies
  arising in primary care from un-reconciled
  prescription changes made during an admission to
  hospital

Process measures
Impact measures
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Key skills for medicines reconciliation

• Effective communication
• Technical knowledge
• Therapeutic knowledge

You need all 3 to be competent to reconcile!
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That concludes this part of the programme

• Dr Bruce Warner Senior Pharmacist National
  Patient Safety Agency