Medicines reconciliation Flashcards
What is medicine reconciliation?
- The process of obtaining an up to date and accurate medication list
When should med rec happen?
- Transferring between different settings
- Hospital discharge
Importance of med rec
- Reduce risk of medication errors and adverse effects
- Ensures continuity of treatment
- Provides best care
- Reduces waste
- Efficient use of time
- Improves patient involvement
How to carry out a medication reconciliation (3 C’s)
- Collect: info about patients med including DH
- Checking: that the info is accurate by comparing to other sources (minimum of two resources)
- Communicating: with patient and members of the MDT
How to take a drug history (DHx) step 1
- Before seeing patient
- Check PMH, PC, possible diagnosis and SCR
How to take a drug history (DHx) step 2
- Starting the convo
- Introduce yourself — smile, eye contact, state your name and role, and ask ‘Is
it OK to talk about your medicines?’ - Explain to the patient and/or their carer why the history is being taken
- Use a balance of open-ended questions (e.g., what, how, why, when) with
closed questions (i.e., those requiring yes/no answers) - Structure the conversation around their medication or a GP list if available
- Avoid jargon — keep it simple
- Clarify vague responses with further questioning or by using other sources of
information
Taking drug history step 3
- What medicines should you enquire about?
- All regular and when required med?
- Recently stopped or changed medication? Antibiotics?
- Allergies?
- Different formulations
- Smoking, alcohol, recreational drugs?
- OTC, herbal or online remedies?
Drug history step 5
- Who looks after your medicines at home?
*Do you have any difficulties taking your medicines? - Are they in separate boxes or one big pack? e.g., multi-compartment compliance
aids (MCAs) or original containers - Have there been any recent changes to your medicines or any recent hospital
admission? - Do you have any of your own medicines with you? Do you have any in your locker?
- Do you have any at home? Do you know how much you have left at home? (for
discharge) - Do you get medicines from anywhere other than the GP? e.g., home delivery,
hospital, chemo (refer), clinical trial, MCAs.
Drug history 6
- Generic name of the drug
- Strength
- Dose
- Frequency - if its specific days which days?
- Formulation
- Route of administration
- Device and brand for injectables
Drug history step 8
- Patient or patients representative
- Patients medicines
- Patients medical records
- Patients GP
- Care home records
- RP
High risk medication and conditions
Why are anticoagulants high risk and name some examples
MAR chart
- Source used for DH
- Medicine administration record
Difference between DHx and med rec
- Medicine reconciliation is a multi step process
- Drug history is one step of the med rec process
Checklist
Patients own drugs POD
- This is also another source used for DH
CHECK:
What extra information do you need to know about warfarin?
- indication & target INR
- date started and duration
- dose and strengths
- who monitors?
- what time taken?
- PODs
- any problems?
What extra information do you need to know about insulin
Many types, must get correct one
* brand (and origin)
* device
* dose
* storage requirements
o In use, store at room temp
For max 4 weeks
What extra info do you need to know about antibiotics
- What is the infection?
- Where is it?
- Course duration?
- When did it start?
- Has patient been taking them?
What extra info do you need to know about steroids
- recent courses?
- Reducing regimen?
- long term?
- chemo?
