Medicines reconciliation

Medicines reconciliation is the process of ensuring that a hospital patient's medication list is as up-to-date as possible. It is usually undertaken by a pharmacist and may include consulting several sources such as the patient, their relatives or caregivers, or their primary care physician. In the United Kingdom, guidelines on medicines reconciliation are provided by the National Institute for Health and Care Excellence (NICE) in collaboration with the National Patient Safety Agency.[1] In accordance with these, it should be carried out within 24 hours of admission to hospital.

Importance

Research has shown that, on average, there is around a 20% discrepancy between medications prescribed on admission to hospital and the true medication list for a given patient.[2] Chronic medications are stopped in about 11% of the patients after elective surgeries[3] and 33% of the patients after admission to intensive care unit.[4] The most common omissions are inhalers and analgesia. There are also a small minority of errors in prescribing drugs such as insulin or warfarin, which could have catastrophic consequences including death of the patient. Pharmacist involvement help reasons for drug discontinuation being documented[5] and adverse drug reactions being reconciled in the prescription charts.[6] The value of medicines reconciliation is in noticing and correcting these errors before they have a chance to adversely affect the patient concerned.

References
  1. National Patient Safety Agency. NICE NPSA medicines reconciliation adults in hospital. Patient Safety Alert, Reference number 1035. Issue date 1 December 2007. London, UK.
  2. Urban R, Armitage G, Morgan J, et-al. Custom and practice: a multi-center study of medicines reconciliation following admission in four acute hospitals in the UK. Res Social Adm Pharm. 2014; 10: 355-68. PMID 24529643
  3. Bell CM, Bajcar J, Bierman AS, Li P, Mamdani MM, Urbach DR. Potentially unintended discontinuation of long-term medication use after elective surgical procedures. Arch Intern Med. 2006; 166: 2525-31. PMID 17159020
  4. Bell, Chaim M.; Rahimi-Darabad, Parisa; Orner, Avi I. (2006-09-01). "Discontinuity of chronic medications in patients discharged from the intensive care unit". Journal of General Internal Medicine. 21 (9): 937–941. doi:10.1111/j.1525-1497.2006.00499.x. ISSN 1525-1497. PMC 1831608. PMID 16918738.
  5. Yeung E. Are we legitimately stopping medications? Use of pharmacist and junior doctor teaching to improve medication reconciliation. Br J Gen Pract. November 11, 2016. London, UK.
  6. Yeung, Eugene Y. H. (2015-10-01). "Adverse drug reactions: a potential role for pharmacists". The British Journal of General Practice. 65 (639): 511. doi:10.3399/bjgp15X686821. ISSN 1478-5242. PMC 4582849. PMID 26412813.


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