What is medicines reconcilliation?

The SPSP Medicines Clinical Advisory Group has developed a national driver diagram for medicines reconciliation.

The operational definitions for measuring medicines reconciliation on admission and discharge have been developed based on the Chief Medical Officer letter issued in September 2013 (SGHD/CMO(2013)18) (Safer use of medicines)

Operational definitions for medicines reconciliation in General Practice can be found here

Medicines Reconciliation Care Bundle

Care bundles are a quality improvement tool which can drive improvement by standardising processes to deliver optimum care.

Impact

NHS GGC ran a large scale implementation of the medicines reconcilliation in 2015/16. Initially they started with a test of 5 GP practices and eventually spread to over 200 practices. The care bundle was implemented by 93% of NHS GGC GP practices and resulted in process improvements.

The reflections from GP practices on the benefits of the
work were overwhelmingly positive:

“There has been a significant increase in patient safety by reducing prescribing errors by doctors undertaking the meds rec. I feel this has been one of the most valuable enhanced services that we have ever been involved in.”

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Why medicines reconcilliation is important:

  • 38% of readmissions in one study (of 108 cases) are considered to be medicines-related.
  • 61% are identified as preventable (Witherington et al 2008).
  • Among older patients (65+ years) 14% are discharged with medication discrepancies and have a higher risk of being readmitted to hospital within 30 days (Coleman et al 2005).
  • 72% of adverse events after discharge are due to medications (Forster et al 2004 p345).

Patients frequently move across different parts of the health service.  It’s vital that an accurate record of what medication a patient is taking is maintained and communicated appropriately.  But medication reconciliation is not easy to do when the service can be fragmented and there is no single patient record.