Introduction to the Medicines Reconciliation care bundle

1. Introduction to the Medicines Reconciliation care bundle

2. Aims of session • Introduce the Meds Rec Care Bundle • Discuss measures, operational definitions and rationale. • Discuss data collection process and frequency • Discuss ways to involve patients • Share resources, challenges and learning

3. Medicines Reconciliation – what is it? National Definition “The process that the healthcare team undertakes to ensure that the list of medication, both prescribed and over the counter, that I am taking is exactly the same as the list that I or my carers, GP, Community Pharmacist and hospital team have. This is achieved, in partnership with me, through obtaining an up-to-date and accurate medication list that has been compared with the most recently available information and has documented any discrepancies, changes, deletions or additions resulting in a complete list of medicines accurately communicated”

4. Medicines Reconciliation – why is it important? Patient Safety! Lots of evidence of patient harm in literature: 72% of adverse events after discharge due to medications (Foster et al 2004) 38% of readmissions considered to be medicines related, 61% of these preventable (Witherington etc al 2008) 14% of pts > 65 years old are discharged with medication discrepancies and have a higher risk of readmission (Kohn et al 2007) etc etc etc…… 19.3% of GP negligence claims relate to prescribing and medication (3.8% of these due to supplying incorrect or inappropriate medication)

5. Medicines Reconciliation – why am I here?! Want to reduce patient harm and improve patient safety relating to medicines Meds rec one piece of this wider “safer medicines” workstream Will do meds rec already within your practice but 1) is there a standard process? 2) is it safe and reliable? 3) could it be improved? 4) is it done for “every patient every time”?

6. Perception versus Reality

7. Medicines Reconciliation in primary care How do we perform meds rec accurately? Develop standard reliable process for dealing with discharge information in your practice Record that meds rec has been done (read code) Record action taken on any changes (read code(s)) Record discussion of any changes with pt (read code(s)) Do this using a “care bundle”….

8. Medicines Reconciliation – care bundle measures Has the Immediate Discharge Document (IDD) been workflowed on the day of receipt? Has medicines reconciliation occurred within 2 working days of the IDD being workflowed to the GP? Is it documented that any changes to the medication have been acted on? Is it documented that any changes to the medication have been discussed with the patient or their representative within 7 days of receipt? Have all the above measures been met?

9. Medicines Reconciliation Care Bundle – Data Collection Data collected is for local use, to allow practice teams to gain a better understanding of their systems and make the necessary changes. Data is displayed in a run chart and allows you to see improvements over a period of time. Data for improvement - not judgement.

10. Medicines Reconciliation – local GG&C practice results Target 90% General improvements to process: small tests of change with PDSA cycles Improvement – stable but not reliable Beginning to see reliable process? Trakcare!

11. Medicines Reconciliation

12. GG&C discharge “issues”

13. Medicines Reconciliation – practical hints and tips Collecting care bundle compliance data on 5 patients per month Prioritise patients over 75 years old on 10 or more medicines if insufficient patient numbers in this cohort per month, reduce the number of medicines or reduce the age First data return in June – consider using first couple of months to determine your patient cohort and think about your systems and processes Docman can be used to find your discharged patients Using EMIS/Vision standard reporting template may make it easier for you to data collect/measure Info on reporting mechanism to follow – national template being developed

14. Medicines Reconciliation – practical hints and tips Measure 1 Difficult to give exact hints and tips as how practices process discharge Rxs will vary depending on how they receive them….. "Workflow" does not necessarily mean using electronic methods or Docman. This wording relates to whatever existing process you have in place to move the necessary written/electronic paperwork to the relevant personnel for timeous action Important point is that the day it was “workflowed” is clearly visible when it comes to data collection Usually an admin/receptionist function

15. Medicines Reconciliation – practical hints and tips Measure 2 Strongly recommend this is done by a clinician as likely clinical decisions will be made on a discharge prescription Use Read code #8B318 This is set up in EMIS template/Vision guideline You don’t have to use read codes however needs to be clearly recorded to aid data collection

16. Medicines Reconciliation – practical hints and tips Measure 3 Likely this will be completed at same time as Measure 2 - clinician to document any changes to medicines on discharge All read codes available on same EMIS template/Vision guideline Some practices may wish to use synonyms Again important point is it is easy to find when it comes to data collection Tick N/A only if there are no changes to the meds following discharge – this equates to a Yes for the care bundle compliance

17. Medicines Reconciliation – practical hints and tips Measure 4 This is the measure most practices struggle with Practices have been inventive about how to communicate changes Gold standard = face to face or telephone Note on the repeat slip of changes Letter to patient Some GPs ask competent member of admin staff to contact patient with changes Method will depend on patient Use read code #8B3S0

18. Measure 5 Have all measures been met? Yes or No Bundle compliance is a team effort and needs support from admin and all those involved in your meds rec process in the practice Can be collated by anyone in team – admin, practice manager, GP, nurse…. Important thing is to look at your data to identify potential improvements to the process: small tests of change and PDSA

19. Medicines Reconciliation – what’s in it for you?! Bundles, Trigger Tool and Safety Climate Survey recognised evidence for GP appraisal Safety is core to revalidation Standard robust reliable process reduced variation more efficient process workload benefits less stress Improved practice team working

20. Medicines Reconciliation – what’s in it for you?! GG&C acute services also concentrating on meds rec Whole system approach to improving meds rec has primary care, secondary care and ultimately patient benefits Potentially fewer admissions Who wouldn’t want to improve patient safety……?

21. Care bundles • Shed new light on our current practice • Act as a catalyst for improvement in care • Can lead to increased awareness

22. Any Questions?