Creator Sam Carvell, Amber Wynne, Sue Coppack Version 1 Review Date Medicines Reconciliation Standard Operating Procedures Purpose of SOP This standard operating procedure (SOP) provides a framework for Pharmacy Technicians and Pharmacists to undertake medicines reconciliation during the reception medical screening for all men entering HMP Berwyn. It outlines the medicines reconciliation process and applies to all Pharmacy Technicians, Pharmacists and any other Healthcare staff at HMP Berwyn who will be involved in the process of medicines reconciliation. This document aims to standardise the processes for collection, documentation and verification of a patient s current medication history. Following these processes enhance the quality of the patient s journey, reduce risks of misuse of medication, and facilitate the medication process; by improving the accuracy and the efficiency of medication used during their stay. SOP Ref Average Time to 30mins Operate Project/System SystmOne Owner Tools / Equipment Medicines reconciliation form Page 1 of 15
Main Operating Steps Key Points 1. Medicines Reconciliation - Drug and Allergy history taking Explanation / Examples / Links/ Diagrams On arriving in reception ensure that all reception staff (both prison and healthcare) are aware of who you are and why you are there. Ensure reception staff are aware that all medication found in a man s property during reception is placed in a green All Wales Bag for Life. Reception staff should complete the patient s name and date of birth/prison number on the front of the bag before filling. When all medication (including canteen/ OTC) has been removed from the man s property and placed in the green bag, it should be handed to a member of the pharmacy staff in reception. It is important for the reception healthcare team to brief themselves about the men that they are due to see, this can be done by reviewing their SystmOne record; taking note of any warnings or alerts listed. A printout of current medication can be produced from SystmOne by following the guidelines in the explanation. Search for the patient on SystmOne, the following menus may be useful: - Patient s medication chart, view all appropriate tabs - Regular & IP, As Required, Once Only and On Admission - Medication for medication history - Sensitivities & Allergies - Tabbed Journal for all consultations/interactions with patients. This can be searched by specific wording. Search for patient using name or prison ID Page 2 of 15
Healthcare documentation will be collected by prison reception staff when the men arrive. A member of healthcare will collect this documentation for review. A healthcare summary sheet will be included, and using this initial information and SystmOne record you should prioritise the men in order of being seen. Men should be prioritised on their healthcare requirements, for example those with medications or complex conditions should be seen first. This allows the GP as much time as possible to review the man s records, and should avoid a delay in prescribing, and therefore supplying the man with his medication. 2. Reception consultation Select Medication from the menu on the left side of the screen Select current medication from the drop down menu at the top of the screen Right mouse click anywhere on the medication screen and select Table RTF This will produce a document showing all current medications with relevant issue and review dates, and in possession status. This document can be printed to support the medicines reconciliation process. When the man enters the consulting room all healthcare team members should introduce themselves and explain who they are and what they re there to do. Speak to the patient in an appropriate manner, maintaining patient confidentiality at all times. One member of the healthcare reception team should confirm the man s identity by asking them to confirm their Page 3 of 15
name, prison number and date of birth. On the medicines reconciliation form complete all available patient details. The nurse running the healthcare screening will begin questions from the SystmOne template; any relevant information should be recorded on the reverse of the medicines reconciliation sheet (appendix 1), e.g. diagnosed conditions, previous relevant drug history and any current problems. At the medication section of the screening the nurse will pass questioning to the pharmacy technician / pharmacist. Take an accurate drug history, completing all information collected onto the front of the medicines reconciliation form. Under medication, firstly note down all medication that matches up exactly with what the patient has prescribed on SystmOne. In the drug column state the drug, strength and form, complete the dose and frequency columns and then the possession status as IP (in possession) or NIP (not in possession). Be sure to clarify details if any medications or doses differ from those on transfer documents, PODs, or SystmOne record. Ask about medication purchased from the canteen / OTC - Any relevant details should be recorded on the reverse of the form. Ask about any recent courses of antibiotics and steroids, or if the patient has any weekly tablets, monthly injections, or topical preparations. te down any brand specific names, device types that have The purpose of completing this sheet is to highlight any errors or omissions and provide as much background information as possible for the clinical pharmacist. The form should be completed as part of the healthcare reception process. e.g. for insulin, the source and presentation of the insulin; porcine / kwikpen, 3ml cartridge. Page 4 of 15
not been specified, If the patient usually takes any of their medication at different times of the day or at a different frequency, or has a different strength from that which has been prescribed on admission, mark this on the form. Where possible, check SystmOne to see when the change was made. For patients prescribed methadone, check if they have an electronic or paper record. Confirm dose with man and if they have been taking continuously for the last week, note any missed dose during this time. If it is a paper record it needs to be taken to the prescriber immediately in order to continue supply. If patient is currently prescribed patches, check if they have a patch attached, make a note of where on the body is it positioned and when it was applied. Check the patient s allergy status and complete the section of the medicines reconciliation form. If the patient has an allergy, try to determine the specific drug and define the type of reaction that occurred. If the patient has no known allergies, record NKDA. e.g. 'Penicillin - rash and blisters', 'Erythromycin severe sickness. Use all appropriate and available sources of information to build a comprehensive history. Record the amount of patients own medication held and check that the directions on labelled boxes match current prescription. For transfers these can include: - Patient - SystmOne - Patient s own medication - Check dispensing and expiry dates, directions and record quantities held - Medical notes For remand theses include: Page 5 of 15
- The GP surgery - The patient s regular Community Pharmacy - GP letter/fax/repeat list - Print out from Nursing/Residential home or hospital Discuss any issues that the patient may have with their medication, and record on reconciliation form using patients own words (Use quotation marks when needed) te any observations that you, or other members of the healthcare team have made. Complete your name, sign and the date form when completed e.g. suspected non-compliance, lack of understanding of medication, communication problems, any recent changes to medication prior to admission, any doubts or difficulties encountered whilst taking drug history in the Pharmaceutical Care Issues / Other Information section of the medication reconciliation form The completed medicines reconciliation form, any associated paperwork, and patient s own medications should be returned to pharmacy so that information gathered can be transferred to SystmOne by a medicines management technician. 3. Smoking Status Only medications and medical history information should be taken back to pharmacy. Ensure that no patient belongings are included in with the POD s. Circle the appropriate response to whether the man is a smoker or not, and include any details such as; Amount smoked, for how long, and quit date if applicable. If a smoker that man will have two options; to take a vape provided by the prison or to sign up to a 12 week smoking cessation programme provided by the healthcare team. Circle the option chosen on the form. Page 6 of 15
If the smoking cessation route is taken then the man will be provided with lozenges in reception. He will be given enough to last until his first clinic on Friday. A carbon monoxide reading along with assessment of the patients smoking habits will determine which strength of lozenge is most appropriate. For full details of smoke free options please refer to smoke free SOP. Arrival on Tuesday 3 x 20 lozenges issued Arrival on Wednesday 2 x 20 lozenges issued Arrival on Thursday 1 x Lozenges issued 4. Patient s own medication Medication that the patient has previously purchased can remain within their property, however cannot be returned to them unless authorised to do so by a GP. Pharmacy staff must examine these medications to ascertain whether they have been purchased rather than prescribed or taken from others. Any dispensing labels or presence on SystmOne record will indicate that they have been prescribed, and do not belong to the patient, so can be removed from property. Medications confirmed as purchased by the men will be recorded on a blue property card by prison reception staff, as a record of their belongings for storage. 5. Completion of Medicines Reconciliation Template on SystmOne Page 7 of 15
On receipt of the medicines reconciliation documents and PODS a medicines management technician assigned to reception administration, will transfer all relevant information to the Medicines Reconciliation Template on SystmOne. This can be accessed from the patient s clinical tree to the left of patient home screen. Tick the relevant boxes and list the sources used to confirm the drug history, including the name of the technician who carried out the medicines reconciliation. The technician should enter medicines and allergy list to record on admission medications, marking them as history checked if appropriate. This will aid the prescriber when reviewing all on admission information about the patient. Page 8 of 15
Record the allergy status and define the reaction where possible. On the second tab record any changes to medication or recent stopped treatment as well as any other relevant information from the medicines reconciliation form. This will include entering details of all medication being taken up to the point of reception, making reference to medication that has been stopped, started, withheld, or had doses changed; also record items that the man has in his property that are no longer prescribed. Page 9 of 15
When you are satisfied that all information is included save the template to the patients record. At this stage ensure that the patient has been added to the virtual surgery for review by the GP (If patient is taking regular medication) Any clinical queries regarding a man s medication or the reconciliation process should be directed to a pharmacist for advice. 6. Patients own medication Patients own medication can be re-used following guidance in appendix 2 of this SOP. Any medications not suitable for reuse should be disposed of following medication waste policy. Page 10 of 15
7. Errors If an error is discovered that occurred during the original dispensing, follow these procedures: - If the error occurred in a community pharmacy, complete a Community Pharmacy Error Record sheet, keep the item involved or photocopy the label/box if possible. Inform the pharmacist, the community pharmacist involved also needs to be informed to bring the problem to their attention, as tactfully as possible. - In some cases it may be necessary to complete a DATIX form and some cases will need to be brought to the attention of the appropriate pharmacist in connection with the relevant medication error group. If you are in any doubt about how to proceed with reporting an error consult the clinical pharmacist you are working with, or the dispensary manager. 8. Appendix 1 - Medicines Reconciliation Form (HMP Berwyn) 9. Appendix 2 Patients Own Drugs (PODs) OWN DRUGS (POD) assessment checklist END OF OPERATION Page 11 of 15
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Appendix 1 - Medicines Reconciliation Form (HMP Berwyn) Patient name Date of Birth Prison number House Community Room Completed by Date completed Any drug / other allergies? / If yes, state drugs and nature of reaction Comments: Smoker Smoker Smoke Free Programme / Given Vape Pack : / / Is patient currently prescribed any medication? YES (complete details below) / NO Medication Drug Dose Freq Possessio n Status (IP / NIP) Quantity Comments Page 13 of 15
Main Operating Steps Key Points Explanation / Examp Does patient order medication from canteen? If yes please state details Illicit Drugs: If yes please state details Pharmaceutical Care Issues /Other Information: Controlled drugs, reducing/variable doses / non-compliance Sources used for drug history (tick if used) Patient SCR Checked Community Medical Record Medical record Other: PODs SystmOne Record GP Surgery / repeat list / letter / fax Community pharmacy Print Sign Date Drug history Confirmed By Reviewed by Pharmacist Transferred to SystmOne Page 14 of 15
Main Operating Steps Key Points Explanation / Examp APPENDIX 2 - PHARMACY: PATIENT S OWN DRUGS (POD) ASSESSMENT CHECKLIST Unsuitable For use Refer to a pharmacist Is the medicine in a suitable condition? I.e. in original dispensed box/bottle, clean, dry, with no signs of deterioration, in good working order. Is the medicine a cytotoxic drug? Does the medicine have a dispensing label? Consider relabeling if passes other criteria. Otherwise unsuitable for use. Is the label typed, legible and bears the correct patient name? Is the medication: A clearly identifiable drug, in an original container, marked with an expiry date? Unsuitable For use Unsuitable For use Has the drug been dispensed within last 6 months: loose tablets/liquids/open creams? OR Is the blister pack / device / unopened creams within the manufacturer s expiry date? Satisfied? Is quantity sufficient? Unsuitable For use Unsuitable For use Check drug identity: Does the name on the label match the drug inside? Re-label as per procedure Endorse pharmacy box on prescription as POD Relabelled Inhalers / GTN Spray if prescribed, return to patient, endorse Returned POD. Unsuitable For use Unsuitable For use Examine contents, any mixed or dirty tablets, check blisters intact, Contents acceptable? Satisfied? Is quantity sufficient? Re-label as per procedure Endorse pharmacy box on prescription as POD Relabelled Page 15 of 15 Additional Information Ensure details of all medication not returned to patient including NRT and those purchased from canteen are noted on Medication Reconciliation form