AN AUDIT OF MEDICATION RECONCILIATION

An Audit Of Medication Reconciliation

An Audit Of Medication Reconciliation

Abstract

This study aims to find if pharmacists playing an important role in preventing medication errors through medicine reconciliation. The main focus will be to assess whether St Georges acute medical ward is currently meeting the targets set out by NICE/NPSA guidelines in relation to medication reconciliation.

An Audit Of Medication Reconciliation

Table of Contents

Abbreviations5

Chapter I: Introduction6

Research Question of the Study6

Aims of the Study7

Objectives of the Study7

Significance of the Study7

Background of the study8

National Patient Safety Goals - Mandatory JCAHO Requirements9

Impact of Medication Reconciliation In Reducing Medication Errors12

Rationale of the Study14

Chapter II: Literature Review16

What NICE is16

What NICE does16

How NICE works17

Impact of Pharmacist recorded MR in Identifying And Preventing Medication Errors18

What it is and why it is important18

Chapter III: Methodology23

Ethical Approval23

Subjects and Setting23

Study Design23

Instrument24

Pilot study24

Sample24

Sampling strategy24

Inclusion and Exclusion Criteria25

Sample Size25

Data Collection26

Expert Group26

Chapter IV: Results and Discussion27

The Ratio of Technician to Pharmacist Reconciliation28

Time scale of Medication Reconciliation (MR)28

Discrepancies29

Severity of discrepancy31

Resolution of discrepancies:31

Discrepancies which were rated as Severe (n=16)32

Omission of important medication32

Discrepancies which were rated as Moderate (n=24):33

Discrepancies which were rated as Mild (n=182)33

Limitations in the Study35

Sample Size:35

Setting:35

The Expert Group36

Clinical Significance Of Pharmacy Intervention36

Chapter IV: Conclusion39

References41

Appendix42

An Audit Of Medication Reconciliation

Abbreviations

NICE: National Institute for Health and Clinical Excellence

NPSA: National Patient Safety Agency

ADEs: Adverse drug events

ISMP: Institute for Safe medication Practices

OTC: Over the counter

GP: General practitioner

MR: Medication reconciliation

An Audit Of Medication Reconciliation

Chapter I: Introduction

Medication reconciliation is a process that includes the collection of a complete medication list from the patient at the point of entry; using that information when prescribing medications; and comparing the new orders against the original medication list to ensure that all of the correct medications are ordered or held as appropriate. This process does not end with admission orders, but has application during transitions of care and at discharge. Errors can happen at any point in the process particularly because each of these elements usually requires additional transcription steps. Most mistakes with reconciliation originate from discontinued medications that are continued inadvertently in the hospital, the omission of a medication, failure to discontinue a contraindicated medication, failure to resolve discrepancies in dosages or routes, and inadvertent dose duplications. Furthermore, it is very important to mention that although this audit is aimed at reconciliation at admission, but we also need to make sure that patients are receiving the corrected medication at and after discharge.

Research Question of the Study

Are pharmacists playing an important role in preventing medication errors through medicine reconciliation?

Aims of the Study

The aim of this study is to assess whether St Georges acute medical ward is currently meeting the targets set out by NICE/NPSA guidelines in relation to medication reconciliation.

Objectives of the Study

The objectives of this study are;

•To evaluate the time scale of the medicines reconciliation process within the working hours

•To identify discrepancies

•Attempt to qualify these discrepancies

•To observe if the interventions are made by the pharmacy

Significance of the Study

Pharmacist's interventions are considered very important to improve the quality of health care system ...