Reconciliation of Medicines on Admission to Hospital Policy Title State previous title where relevant. State if Policy New or Revised Policy Strand Org, HR, Clinical, H&S, Infection Control, Finance For clinical policies only - state index category Links to National Regulatory Standards: Care Quality Commission(CQC) NHS Litigation Authority (NHSLA) National Institute for Health & Clinical Excellence (NICE) Policy Lead/Author Job titles only Consultation State year and the individuals, groups, committees, service users, working partners etc. you have consulted with Ratification State ratified by whom - Policy Ratification Group, Executive Committee or Director Equality Impact Assessment Implementation Plan Reconciliation of Medicines on Admission to Hospital Revised Clinical Sub Category: Medicines Management National Institute for Health & Clinical Excellence (NICE) National Patient Safety Agency (NPSA) Senior Clinical Pharmacist 2012 - Medicines Management Committee, Inpatient Unit Managers, Clinical Alignment Group 2014 - Medicines Management Committee, Physical Health, LSMS Practice Development Team Matrons, Lead Nurses Policy Ratification Group Yes Yes Month/year policy first developed March 2012 Months/years policy reviewed Keep review dates in chronological order December 2014 Next review due December 2017 Review details Revisions made, changes etc include page numbers and paragraphs For Corporate Executive Support use Date Policy First Uploaded to Intranet March 2012 Dec 2014 - Minor amendments to the policy. Date Policy Revised & Reloaded to Intranet December 2014 Version 1.1 December 2014
Reconciliation of Medicines on Admission to Hospital Ref. Contents Page 1.0 Introduction 3 2.0 Purpose 3 3.0 Objectives 3 4.0 Definitions 3 5.0 Duties 4 6.0 Committee/Group Responsible for Approval of this Policy 5 7.0 Process 5 8.0 Monitoring Compliance 6 9.0 Equality Impact Assessment 6 10.0 Training 6 11.0 Data Protection Act and Freedom of Information Act 7 12.0 References 7 13.0 Links to other Policies and Procedures 7 Appendices Appendix 1 Fax Template 8 Appendix 2 Audit Tool 9 Review and Amendment Log Version Reason Status Date Description of Change V1.0 Alignment of policies following TCS Ratified V1.1 Minor Amendments Ratified March 2012 December 2014 New Policy for BCPFT Amendments to the following: Page 4 - section 5.0, Page 5 - sections 7.1 and 7.2, Page 6 - section 8.0, Appendix 1 and 2. Version 1.1 December 2014 2
1.0 Introduction Medication errors are one of the leading causes of injury to hospital patients. Experience from data collected as part of the Institute for Healthcare Improvement (IHI) 5 million lives campaign has shown that poor communication of information at transition points is responsible for as many as 50% of all medication errors and up to 20% of adverse drug reactions that occur in hospital. The National Patient Safety Agency (NPSA) has reported the number of incidents of medication errors involving admission and discharge as 7070 with 2 fatalities and 30 that caused severe harm (figures from November 2003 and March 2007). Typical problems that can occur at transition points when medicines have not been reconciled include: The patient might receive the wrong dose, strength or formulation of their medicine The patient may not receive their medicine at all There could be delays to a patient s treatment while these issues are resolved Greater risk of drug interactions, adverse effects etc Additional staff time spent on resolving issues Pharmacy could order in the wrong medication for a patient The patient s stay in hospital might be extended or their transfer may be delayed Confusion and lack of confidence in the system, for patients, their carers and families, as well as for health care professionals. Medicines reconciliation ensures that patients receive all intended medications and no unintended medications following a move from one care setting to another. This Policy must be read in conjunction with the Trust s Medicines Policy (see information re. NPSA alerts etc) and other Clinical Policies e.g. Lithium Policy. 2.0 Purpose The purpose of this policy is to guide Black Country Partnership NHS Foundation Trust (BCPFT) staff in the implementation and provision of medicines reconciliation to patients admitted to all inpatient wards within the Divisions and Home Treatment teams. 3.0 Objectives There is a reviewed and ratified policy for the reconciliation of medicines on admission to hospital and Home Treatment teams. 4.0 Definitions Medicines reconciliation has been defined by the IHI as the process of obtaining an up-to-date and accurate medicines list that has been compared to the most recently available information and has documented any discrepancies, changes, deletions and additions, resulting in a complete list of medications, accurately communicated. Basic reconciliation involves the collection and documentation of a patient s current list of medicines. Version 1.1 December 2014 3
Full reconciliation involves identifying any discrepancies between the current list of medicines and the most recently documented list of medicines, acting on this information and recording the outcome. 5.0 Duties Medicines reconciliation is the responsibility of all staff involved in the admission, treatment, monitoring, transfer and discharge of patients within BCPFT. Medical Director To ensure that all doctors carry out medicines reconciliation according to the Trust s Policy. Chief Pharmacist To ensure that all members of the pharmacy team carry out medicines reconciliation according to the Trust s Policy. Director of Nursing To ensure that all nursing staff carry out medicines reconciliation according to the Trust s Policy. Ward/ Team Manager To ensure that all ward/team staff carry out medicines reconciliation according to the Trust s Policy. Admitting/ Team Doctor The responsibility of the admitting/team doctor is to: Complete medicines reconciliation for each patient on admission, including medication for physical health and non-prescribed medicines Document which sources have been used for each patient Document any intentional changes of medication Sign the key source documents. Nursing Staff The responsibility of the nursing staff is to: Contact the patient s GP, obtain a faxed list of current medication (this may be delegated to non qualified staff) and attach to the patient s treatment sheet. Ask the patient or patient s relative/carer to bring their own medication in Ensure that medicines reconciliation has been completed for each patient Follow up any highlighted omissions or discrepancies with medical staff. Pharmacy Technician The responsibility of the Pharmacy Technician is to: Check the GP list of medication. If not yet received, attach a medicines reconciliation note to the front of the treatment sheet and recheck on next visit to the ward. For any urgent matters contact the GP receptionist for a list Check patient s own medication, if available Inform the pharmacist of any new admissions and any discrepancies found Endorse the front of the treatment sheet with findings. Clinical Pharmacist The responsibility of the clinical pharmacist is to: Ensure that medicines reconciliation is carried out for new admissions Version 1.1 December 2014 4
Check the GP list of medication Act on any discrepancies found by the pharmacy technician Contact the prescriber/duty doctor to clarify any discrepancies where possible Endorse the front of the treatment sheet with findings. 6.0 Committee/Group Responsible for Approval of this Policy The Medicines Management Committee is responsible for the approval of this policy. 7.0 Process 7.1 Stage 1: Collecting (admitting doctor/ nurse) The initial medicines reconciliation process should be completed within 24 hours of admission, except at weekends and bank holidays. Initially the medication history will be taken by the admitting doctor from at least two of the following sources: A recent computer print-out from the GP s surgery or other confirmation of current medication prescribed by the GP Patient s own medication Verbal information from the patient, relative or carer The most recent treatment chart/prescription from the discharging/ transferring hospital Patient notes from previous admissions Referral letter Care home or social care Medication Administration Records (MAR s) Clinic letters Community pharmacy Patient Medication Records (PMRs) Care notes/oasis for recent psychiatric medication Patient held information books/cards e.g. Lithium, Insulin Passport, Anticoagulant Therapy, Methotrexate Information from community nurses The medication history should be taken from the most recent source and, where possible, cross checked and verified with another source. Cross checking of information is particularly important if the patient cannot confirm the details due to their medical condition or communication difficulties. Nursing staff are responsible for collating above key source information (see appendix 1 for fax template letter). This may be delegated to non-qualified staff, if appropriate. The GP list of medication/mar chart must be attached to the treatment sheet and brought to the attention of the medical team. Caution if patients on certain medications such as clozapine, methadone, buprenorphine, depot injections as these may not always be recorded on GP records. For patients on methadone or buprenorphine, doses must be clarified with Addiction Services before prescribing. The medication history should be documented, signed and dated in the patient s notes/green admission form by the doctor. A note must be made of the source of the information. Any discrepancies between what the patient is prescribed and what they are taking should be noted and the reasons for any variations documented in the Version 1.1 December 2014 5
patient s notes/green admission form. Any intentional changes to the patient s medication should also be recorded and a reason given. The doctor must sign the key source documents e.g. GP list of medication, to acknowledge that they have been seen and confirm any changes. Information about medications for people with communication difficulties should be obtained directly from the GP practice, or recent written confirmation of current medication (e.g. repeat prescription note). 7.2 Stage 2: Checking or Reconciliation (to be undertaken by clinical pharmacists or technicians with appropriate training) Pharmacy staff will perform the checking process on their next routine ward visit. The checking step involves ensuring that the medication history is correct using the above information sources, particularly if they were not available at the time of admission. Any unexplained discrepancies or omissions should be brought to the attention of the medical team, if available and nursing staff informed. Any queries should be documented on the front of the treatment sheet. If medicines reconciliation is carried out by a pharmacy technician, the pharmacist must be notified if there are any discrepancies. Once the medicines reconciliation process is complete, pharmacy staff will sign and date the front of the treatment sheet and summarise any findings. 7.3 Stage 3: Communicating The discharging doctor is responsible for communicating current medication requirements to the GP on the discharge summary/tto. TTOs will detail all continuing medication (not just those that need dispensing). 8.0 Monitoring compliance The audit tool is attached (Appendix 2). Multi-disciplinary audits will be carried out with the support of the clinical governance department. 9.0 Equality Impact Assessment The Black Country Partnership NHS Foundation Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group. The Equality Impact Assessment for this policy has been completed and is readily available on the intranet. If you require this in a different format e.g. larger print, Braille, different languages or audio tape, please contact the Equality and Diversity Team on 0121 612 8067 or email EquqlityImpact.assessment@bcpft.nhs.uk 10.0 Training Training on this policy should be given to all new members of staff who are expected to work under it. Staff should ensure they maintain a working knowledge of this policy and read as often as required to ensure competence under it. Staff should be re-trained on this policy when an incident occurs. Where specific training needs are identified, please contact the pharmacy team for advice/guidance. Version 1.1 December 2014 6
11.0 Data protection and Freedom of Information Act All staff have a responsibility to ensure that they do not disclose information concerning the Trust s activities or about service users in its care to unauthorised individuals. This responsibility applies whether you are currently employed or after your employment ends and in certain aspects of your personal life e.g. use of social networking sites etc. The Trust seeks to ensure a high level of transparency in all its business activities but reserves the right not to disclose information where relevant legislation applies. 12.0 References Technical patient safety solutions for medicines reconciliation on admission of adults to hospital. National Institute for Health and Clinical Excellence and the National Patient Safety Agency. http://www.nice.org.uk/nicemedia/pdf/psg001guidanceword.doc www.npsa.nhs.uk/corporate/news/guidance - to-improve-medicines-reconciliation/ Institute for Healthcare Improvement; 5 Million Lives Campaign. Getting Started Kit. IHI 2007. Generic West Midlands Policy for the Reconciliation of Medicines on Admission to Hospital produced by the West Midlands Clinical Pharmacy Group on Behalf of the West Midlands Chief Pharmacists Network Jan 09 13.0 Links to other policies, procedures or legislation This policy should be read in conjunction with the Trust s Medicine Policy, including information such as NPSA alerts and other Clinical Policies, such as the Lithium Policy. Version 1.1 December 2014 7
Appendix 1 - Fax Template Dear Dr. Your patient: Name Date of Birth NHS Number Address Was admitted to.. on. Please can you provide details of the patient s current prescribed medication along with any known allergies. Please reply by fax or by e-mail (if secure i.e.nhs.net). Fax number:... E-mail address (optional):. Yours sincerely.. Name:.. Designation: Version 1.1 December 2014 8
Appendix 2 Objective of the audit: Audit Standards The objective is to measure current practice in medicines reconciliation on admission of patients to inpatient settings and Home Treatment teams as part of a continuous improvement programme. This includes mental health units and applies to elective and emergency admissions. Data collection tools: This tool can be used or adapted for the data collection part of the clinical audit cycle by the Trust. Patient groups and sample: The patient group is all patients admitted to inpatient hospital services and home treatment teams. An appropriate sample will be selected to monitor the policy. 1. This policy is available in all clinical areas (Clinical Policy Folder/intranet). Standard = 100% 2. There is evidence that Medication Reconciliation has been completed for all applicable patients. Standard = 100% 3. The individual completing the Medicines Reconciliation (both collection of information and verification) is identifiable. Standard = 100% 4. Primary care records* were consulted as part of the Medicines Reconciliation and source identified. Standard = 80% 5. There is evidence (in the sample) that the primary care records have been verified with the hospital prescription. Standard = 100% 6. There is a record of how long after in-patient admission the Medicines Reconciliation was started. Standard = 100% (e.g. 70% within 48 hours of admission). 7. Medication details for patients with communication difficulties have been obtained from primary care records. Standard = 100% 8. The number, type and clinical outcome of prescribing discrepancies identified as part of the Medicines Reconciliation process and clinical outcomes. Summary information for reporting. * Primary care records include GP repeat prescription slip; GP provided admission information; confirmation with GP practice; community pharmacy PMR. Version 1.1 December 2014 9