Medicines Reconciliation A Whole System Approach

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Medicines ReconciliationA Whole System Approach
Every stage, every time for every patient!

• Arlene Coulson
• Principal Clinical Pharmacist, Specialist
  Services
• Gordon Thomson
• Principal Clinical Pharmacist, Urgent Care,
  Medicine

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Why, What, Where, When, Who and How?

• Why implement Medicines Reconciliation?
• What should it consist of?
• Where and when it should occur?
• Who should carry it out?
• How should it be implemented?

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Why implement medicine reconciliation?

• Transitions from one healthcare setting to
  another increase risk of adverse drug events and
  contribute to avoidable hospital visits.
• (Dedhia et al. 2009 Fernandes 2009 Jack et al.
  2009 Ong et al. 2006)

• Improving processes directly improves outcomes.
• REDUCE RISK, HARM AND VARIATION!

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What should it consist of?
Discharge
Admission
Talk to Patient/ Family
Patient Own Drugs/list
Electronic medication records
Patients medicine chart
Electronic medication records
Medicine Reconciliation Documentation
Sources of Medicine Reconciliation
Sources of Medicine Reconciliation
Standardised Medication Reconciliation
Standardised Medication Reconciliation
Document in Electronic Discharge Documentation
Document in Medicines Reconciliation Documentation
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Medicines Reconciliation on admission
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Electronic Discharge Documentation
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Where and When should it occur?
GP Surgery
Community Pharmacy
e
e
Admission to hospital
Out patient
Different levels of care
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• HOME

Medicines Reconciliation on admission to
hospital
Medicine Reconciliation on transfer of care
settings
Medicine Reconciliation at discharge

• HOME

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Who Should Carry It Out?

• It is vital to have medical staff engagement
  right from the beginning!!

• Testing/Implementation collaborative approach
  with Medical and pharmacy staff
• Any health professional can complete medicines
  reconciliation!
• Best to be part of the medical admission
  documentation.
• Medicine reconciliation is reviewed by clinical
  pharmacist

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How should it be implemented?

• Breakdown each step in the process
• Identify the step with highest risk to fail -
  start here!
• Test on 1,3,5 patients (PDSA cycles) on
  admission
• Improve the process in this step so that its 95
  reliable before moving to the other steps
• Prevent failure by standardising the process
• Measure the process regularly to determine
  reliability

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Measurement for improvement accuracy of
medicines reconciliation in Acute Surgical
Receiving Unit
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Next steps for improvement
Every stage, every time for every patient!

• Identify the gaps
• Map out current processes for medicine
  reconciliation.
• Map out the ideal process for medicine
  reconciliation.
• Measure the quality of medicines reconciliation
  in all healthcare settings.
• Invest in areas where its been identified there
  is a gap.
• Reduce variation in practice across NHS Tayside