medicine reconciliation Flashcards
what is medicine reconciliation
Is the process of obtaining an up to date and accurate medication list that has been compared to the most recently available information and has documented any
discrepancies
changes
deletions
additions
resulting in a complete list of medications, accurately communicated
when should medicine reconciliation happen?
Medicines should be reconciled at the transfer of care between different settings
e.g. hospital admission (planned and emergency)
hospital discharge
Movement between settings step up step down and ward/department transfer
Entry into residential/nursing care
why should we do medicine reconciliation?
Better communication between healthcare professionals
Improving the quality and timeliness of information available to clinicians, thereby leading to improved therapeutic outcomes
Improve record keeping
Reduce waste of medicines
Less duplication of effort (time)
Fewer medication-related admissions to hospital
Reduce risk of missed doses, in particular high risk medicines
Reduce medication errors and adverse drug events
Increasing patient involvement in their own care promoting better concordance
how can you carry out medicine reconciliation - CCC
collecting - collecting the information about a patients medicine
Checking- check the information is correct by comparing it to other sources
communicating - communicate it with the patients and members of the multidiscinpilary team looking after the patient
what are the stages of medicine reconciliation
Basic reconciliation (stage 1):Drug History
- accurate identification of the patients current medication
- medication history taking
Full reconciliation (stage 2):
- taking the basic reconciliation and comparing it to medicines which were most recently available for the patient
- seeing there if there is any discrepancies and adding or making changes if necessary
What types of patients pose a challenge when establishing a drug history
Confused patients
Aggressive patients
Unconscious patients or those who are acutely unwell
Patients who are hard of hearing or deaf
Non-English speaking patients
Patients who have a relative or carer administering their medicines
what sources of information can be used to help with medicine reconciliation
The patient relatives/carers Patient's Own Medicines Case notes Previous discharge letter Anticoagulant clinic Medicine Administration record sheet (MARS) Reminder charts/devices District nurse Nursing home Community pharmacist GP Phone call GP repeat prescription slip GP practice print out GP letter Hospital pharmacist records Summary Care Records (SCR)
what is SCR - summary care record
Electronic patient summary contain key clinic information created and maintained by the patient’s GP.
Accessible by authorised pharmacy staff treating patients WITH permission of the patient. (except for exceptional circumstances e.g. emergency access)
Content: Allergies, repeat, acute, discontinued
Whats the problems with PODs
Is it their medicine?
Consent to use and destroy
NOMAD boxes – Stability?
Mixed tablets
what is the steps which needs to be taken for drug missusers
Inform the GP Inform community pharmacy Check patient’s own medication Check the summary care records Confirm the information obtained from the patient with the key worker at drug and alcohol service.
Gather information from GP, PODs
Check the patient’s own medication against … summary care records?
information obtained from the patient with the key worker at drug and alcohol service.
information obtained from the patient with supplying pharmacy
Inform the GP ? / community pharmacy
Endorse the drug card
what kind of questions should you ask
unaskable
- smoking?
- drugs?
what are the alarm bell medicines and conditions
Anticoagulants Steroids OCP/HRT methotrexate Bisphosphonates insulin inhalers
drug misusers clozapine Antibiotics Parkinson Epilepsy Chemotherapy
