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Why implement medicine reconciliation? Improving processes directly improves outcomes. REDUCE RISK, HARM AND VARIATION! 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)
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Medicines ReconciliationA Whole System Approach
Arlene CoulsonPrincipal Clinical Pharmacist, Specialist Services
Gordon ThomsonPrincipal Clinical Pharmacist, Urgent Care, Medicine
Every stage, every time for every patient!
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?
Why implement medicine reconciliation?
• Improving processes directly improves
outcomes.
• REDUCE RISK, HARM AND VARIATION!
•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)
What should it consist of?
Talk to Patient/ Family
Patient Own
Drugs/list
Electronic medication
records
Standardised Medication
Reconciliation
Sources of Medicine Reconciliation
Document in Medicines Reconciliation Documentation
DischargeAdmissionPatient’s medicine chart
Electronic medication records
Medicine Reconciliation Documentation
Standardised Medication
Reconciliation
Document in Electronic Discharge Documentation
Sources of Medicine Reconciliation
Medicines Reconciliation on admission
Electronic Discharge Documentation
GP SurgeryCommunity Pharmacy
Admission to hospitalOut patient
Different levels of
care
Where and When should it occur?
e
e
HOME
Medicines Reconciliation on admission to hospital
Medicine Reconciliation on transfer of care settings
Medicine Reconciliation at discharge
HOME
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
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
% Accuracy
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% Accuracy
Measurement for improvement
% accuracy of medicines reconciliation in Acute Surgical Receiving Unit
Next steps for improvement
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
Every stage, every time for every patient!
