Technical patient safety solutions for medicines reconciliation on admission of adults to hospital

1. Technical patient safety solutions for medicines reconciliation on admission of adults to hospital Implementing the guidance 2007 NICE patient safety guidance 1

2. Definition of medicines reconciliation • Collecting information on medication history to create a full, current list of medicines • Checking the list against the hospital medication chart, ensuring appropriate action for any discrepancies • Communicating through appropriate documentation, any changes, omissions and discrepancies

3. Status of this guidance • The patient safety guidance is based on the best available evidence • The Department of Health asks NHS organisations to implement national patient safety guidance • Compliance with standards C1(b) and D1 will be monitored by the Healthcare Commission

4. What this presentation covers • Background • Action • Current practice • Costs and savings • Resources

5. Background:why the guidance actions matter • In hospitals 9% of reported patient safety incidents involved medication-related harm • Discrepancies in medication taken before and after admission were between 30% and 70%

6. Action 1.1 • All healthcare organisations that admit adult inpatients should put policies in place for medicines reconciliation on admission. This includes mental health units, and applies to elective and emergency admissions

7. Action 1.2 • In addition to specifying standardised systems for collecting and documenting information about current medications, policies for medicines reconciliation on admission should ensure that: • pharmacists are involved in medicines reconciliation as soon as possible after admission

8. Action 1.2 continued • the responsibilities of pharmacists and other staff in the medicines reconciliation process are clearly defined; these responsibilities may differ between clinical areas • strategies are incorporated to obtain information about medications for people with communication difficulties.

9. Current practice • Pharmacists are sometimes involved in medicines reconciliation on admission, but practice varies • Usually a junior (foundation) doctor takes a medical history while managing other priorities • POD (patient’s own drugs) schemes encourage patients to bring their usual medication from home

10. Other work in this area • Safer Patients Initiative • Forthcoming National Prescribing Centre ‘medicines reconciliation – a guide to implementation’

11. Costs per 100,000 population

12. Costs and savings • This patient safety guidance will improve accuracy in medicines reconciliation on hospital admission and result in savings to the NHS from prevented errors

13. Related NPSA guidance • Actions that can make anticoagulant therapy safer. NPSA patient safety alert 18 (2007) • Improving compliance with oral methotrexate guidelines. NPSA patient safety alerts 3 (2004) and 13 (2006) • Other medication-related alerts can be found at www.npsa.nhs.uk/alerts

14. Related NICE guidance • Medicines concordance. NICE clinical guideline (publication expected December 2008)

15. Resources • Costing tools • costing report • costing template • Audit tool • Shared learning database • www.nice.org.uk/PSG001

16. Access the guidance online • Patient safety guidance • ‘Understanding NICE guidance’ – a version for patients and carers • www.nice.org.uk/PSG001 • www.npsa.nhs.uk/alerts