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

               Implementing the guidance




          2007


NICE patient safety guidance 1
                    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
                    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
         What this presentation covers

Background

Action

Current practice

Costs and savings

Resources
                      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%
                                          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
                                        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
                     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.
                               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
                     Other work in this area

Safer Patients Initiative

Forthcoming National Prescribing Centre ‘medicines
reconciliation – a guide to implementation’
                Costs per 100,000 population



Recommendations with significant costs   Annual costs (£)
Additional pharmacists                       15,600
Additional pharmacy technicians              10,500


Estimated cost of implementation             26,100
                          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
                  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
                   Related NICE guidance

Medicines concordance. NICE clinical guideline
(publication expected December 2008)
                           Resources

Costing tools
 • costing report
 • costing template

Audit tool

Shared learning database



www.nice.org.uk/PSG001
            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