Background Medicines reconciliation (MR) is the process of creating the most accurate list possible of all medications a patient is taking.1 The National Institute of Excellence (NICE) published guidance in 2015 on MR for all care settings which advise health and social care practitioners to proactively share and complete accurate information about medication, ideally within 24 hours of the patient being transferred.2
Objective To determine if NICE guidance for MR and communication on discharge is being followed on the paediatric inpatient wards at this Hospital
100% of discharge summaries (DSUMs) include any known drug allergy status
100% of patients have their medicines accurately reconciled by a pharmacist and/or doctor at discharge
100% of relevant DSUMs include the reason for the stop, start or change to medication
100% of patients have their DSUM sent to the GP within 24 hours of discharge
100% of relevant DSUMs include the appropriate supply information for special/unlicensed medications.
Methodology Data was collected retrospectively for 2 weeks on the paediatric wards. Each patient discharged was assessed for eligibility for the audit. The inclusion criteria were: Any patient admitted for ≥24 hour stay in hospital with ≥1 regular medication from the drug history. DSUMs were printed for each patient and a data collection form completed to assess compliance with audit standards using the electronic prescribing system. The data collection form was piloted and amended as appropriate. Ethics approval was not required. Trust approval was obtained. The sample size was 30 DSUMs.
Results Standard 1 was met. All other standards were not met. For standard 2, 63% DSUMs did have regular medication reconciled at discharge. Not having this record will cause errors especially for patients receiving care from different specialist centres. For standard 3, 71% of DSUMs had documented change and standard 4, 83% DSUMs where sent in time. In order for healthcare professionals in primary care to continue medications correctly they need to be fully informed with respect to ongoing treatment in a timely manner; including medication that have been stopped, started or changed and the reason for this. Communication is essential to improve adherence to treatment plans and reduce the likelihood of adverse events caused by failure to prescribe and monitor. For standard 5, 40% included supply information. Seamless care letters are available for special/unlicensed products that can be easily attached to the DSUM and send to the GP and community pharmacy to aid with further supply.
Conclusion This audit has emphasised that MR should take place for every patient on discharge as it is a vital part of communication for all transfer settings. Unintended changes to medication regimens can jeopardise treatment, and increase the risk of re-admission to hospital.
Chief name. Section: 10. Discharge medicines. Trust medicines policy (1st ed.) 2015:7–9.
Medicines optimisation: The safe and effective use of medicines to enable best possible outcomes. http://www.nice.org.uk/guidance/ng5/evidence/full-guideline-6775454
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