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PM2D Delivering Pharmacy Services > Medicines Reconciliation > Flashcards

Medicines Reconciliation Flashcards

1
Q

What is medicines reconciliation?

A
  1. The process of obtaining an accurately list of up to date medication list that has been compared to most recently available information
  2. Documents any:
    - discrepancies
    - changes
    - deletions
    - additions
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2
Q

When should medicines reconciliation happen?

A
  1. Transfer of care between different settings
  2. Hospital admission (planned and emergency)
  3. Hospital discharge or entry into residential or nursing care
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3
Q

Why do medicines reconciliation?

A
  1. Reduces number of prescribing errors
  2. Reduce hospital admissions and re-admissions due to harm to medicine
  3. Reduces the number of missed doses
  4. Improves the quality and timeliness of information which leads to improved therapeutic outcomes
  5. Increased patient involvement in own care promotes better concordance
  6. Reduces waste
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4
Q

What are the 3C’s of medicine reconciliation?

A
  1. Collecting
  2. Checking
  3. Communicating
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5
Q

Describe what the collecting step requires?

A
  1. The most recent patient medication history is taken with the date written down
  2. Analysing the patient medication record and speaking to the patient to identify any new information to add

3.

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6
Q

Describe what the checking step requires?

A
  1. Comparing of information gathered from different sources from one another
  2. Ensuring that the drug, dose and the strength match each other
  3. A recording of what the patient is currently prescribed and what they are taking should be recorded too
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7
Q

Describe what the communicating step requires?

A
  1. Making changes to the patient record or prescription

2. Communicating this to the patient and the health care team

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8
Q

What are the steps to gather information?

A

The usual steps that are taken for a responding to symptoms or new medicine consolation

  1. Confirm patients name and DOB/address
  2. Explain what you are going to do (with consent)
  3. Ask if they have bought your medication or list of medications in
  4. How they take each item
  5. Any other medication
  6. Medicines from pharmacy OTC, shop or internet
  7. Any herbal medicines, vitamins and supplements/homeopathic, recreational drugs or smoking
  8. Recent changes to medication
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9
Q

What are the different sources of information can you use to get the patients medications?

A
  1. Ask patient
  2. Patient’s own drugs (POD)
  3. Repeat prescriptions
  4. Relatives and carers
  5. GP letter and surgery
  6. Reminder chart and devices
  7. Discharge summary
  8. Care home records
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10
Q

What are reliable information sources that you can use to gather history of the patients medication?

A
  1. Computer print out: GP system
  2. Patients repeat prescription request
  3. Verbal information from family or carers
  4. Medical notes from a patients admission previously to the hospital
  5. Patients own drugs (POGS)
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11
Q

What must be recorded for each medication?

A
  1. Name
  2. Dose
  3. Strength
  4. Form
  5. Duration
  6. Indication
  7. Problems
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12
Q

What must be checked on a POG?

A
  1. Patient own drugs must have label checked
  2. Consent to use and destroy
  3. How much at home
  4. How many on repeat
  5. How managed at home
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13
Q

What is the NPSA green bags?

A

Given when the patient leaves the hospital which contains all the drugs they’ve been given

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14
Q

What are the kinds of medicines you need to watch out for during a medicines reconciliation?

A
  1. Warfarin
  2. NOACs
  3. Steroids
  4. OCP/HRT
  5. Methotrexate
  6. Bisphosphonates
  7. Insulin
  8. Inhalers
  9. Anti-biotics
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15
Q

What are the kinds of conditions you need to watch out for during a medicines reconciliation?

A
  1. Drug misusers
  2. Parkinson
  3. Epilepsy
  4. Chemotherapy
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16
Q

What needs to be known when a patient is taking warfarin?

A
  1. Indication and target INR
  2. Date started and duration
  3. Dose and strength
  4. Who monitors
  5. Time taken
  6. Patient own drugs
  7. Any problems?
17
Q

What needs to be known when a patient is taking antibiotics?

A
  1. What’s the infection
  2. Where is the infection?
  3. What is the course of duration?
18
Q

What needs to be known when a patient is taking steroids?

A
  1. Recent courses
  2. Long term use?
  3. Chemotherapy?
19
Q

What needs to be known when a patient is taking contraception/ hormone replacement therapy (HRT)?

A
  1. Missed pills

2. Interactions- antibiotics

20
Q

What needs to be known when a patient is taking Methotrexate?

A
  1. Potentially toxic
  2. Prescribed weekly and not daily
  3. Dose
  4. Strength of tablets
  5. Day and folic acid (prescribed alongside it)
21
Q

What needs to be known when a patient is taking insulin?

A
  1. Brand and origin

2. Device and dose (need correct device to administer treatment)

22
Q

What needs to be known when a patient has parkinson diseases?

A

If they are getting and taking their medication on time

23
Q

What needs to be known when a patient is taking bisphosphonates?

A
  1. Daily or weekly?
  2. What day is it?
  3. Taking it correctly?
  4. Calcium and vitamin D supplements
24
Q

What needs to be known when a patient is using an inhaler?

A
  1. Drug
  2. Strength
  3. Device
  4. Dose and frequency (using correctly)
25
Q

What needs to be known when a patient is a drug missed?

A
  1. Methadone
  2. Confirm doses with GP and DDU
  3. Inform the prescriber and pharmacy
26
Q

What are the specific GP records that are not complete for mental health?

A
  1. Memory clinic- dementia medication
  2. Depots: last give or when due and free
  3. PRN medications:
    - Anticholinergics
    - Hypnotics
  4. Lithium
  5. Clozapine:
    48 hours missing it you have to restart medication dose and get frequent blood tests
27
Q

What are the specialist services in the medicines reconciliation?

A
  1. Clinical trials
  2. Chemotherapy
  3. TB medication
  4. Gum clinic
  5. HIV medication
28
Q

What is the final stage to do in medicines reconciliation after gathering all the evidence of past medication?

A
  1. Check and write drug chart
  2. Discuss problems with doctor
  3. Supply drugs when appropriate
29
Q

What are the main things you should document in a medicines reconciliation test?

A
  1. Route of administration
  2. Formulation (modified release or enteric release)
  3. Specify drug strength
  4. Specify directions when required for medicines that includes frequency, daily dose and indication for use

PM2D Delivering Pharmacy Services (26 decks)

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