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Download Date 05/10/2021 14:45:35 Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom. Item Type Thesis Authors Urban, Rachel L. Rights <a rel="license" href="http://creativecommons.org/licenses/ by-nc-nd/3.0/"><img alt="Creative Commons License" style="border-width:0" src="http://i.creativecommons.org/l/by- nc-nd/3.0/88x31.png" /></a><br />The University of Bradford theses are licenced under a <a rel="license" href="http:// creativecommons.org/licenses/by-nc-nd/3.0/">Creative Commons Licence</a>. Download date 05/10/2021 14:45:35 Link to Item http://hdl.handle.net/10454/7288 University of Bradford eThesis This thesis is hosted in Bradford Scholars – The University of Bradford Open Access repository. Visit the repository for full metadata or to contact the repository team © University of Bradford. This work is licenced for reuse under a Creative Commons Licence. MEDICINES RECONCILIATION: ROLES AND PROCESS An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom Volume 1 Rachel Louise URBAN submitted for the degree of Doctor of Philosophy School of Pharmacy University of Bradford 2014 ABSTRACT Medicines Reconciliation: Roles and Process Rachel Urban Keywords Medicines Reconciliation; Hospital Admission; Medication History Taking; Hospital Discharge; Health Care Professionals; Patient Involvement; Patient Safety; Human Factors; Medication Safety; Care Transitions Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliation- related policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture. i ACKNOWLEDGEMENTS ‘It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of light, it was the season of darkness, it was the spring of hope, it was the winter of despair…’ A Tale of Two Cities, Charles Dickens My PhD has felt like an incredible journey through which I have learned a great deal, especially about myself. This is the result of the fantastic people which I have had supporting me. I have had the most knowledgeable, kind and caring supervisors I could have ever wished for - Julie, Gerry, Alison and Kay. (A special thank you to Julie for being a great friend who has had confidence in me since my undergraduate days and provided me with many opportunities throughout my professional career.) Thanks also to David Alldred for keeping me realistic and grounded, and sharing the taxonomy of medication discrepancies developed by the Universities of Sydney, Leeds and Wisconsin. I must also thank the rest of the Pharmacy Department at the University of Bradford, for your help and support, for keeping me sane with hugs and chocolate when I needed it the most; you are a special group of people and I feel privileged to have spent four years with you. I often affectionately refer to you as ‘brothers and sisters’. It would not have been achieved without the participation of the hospitals, general medical practices, HCPs and support staff involved, for which I am grateful. I would additionally like to thank Bradford Institute for Health Research (BIHR) and Bradford Teaching Hospitals NHS Foundation Trust (BTHFT) for funding the studentship, especially David Smith, Neill McDonald and the rest of my team, who have supported me throughout. Likewise, thanks to Community Pharmacy West Yorkshire for providing a role through which I can continue to research. I have the most amazing group of friends anyone could ever wish for. They have shared my ‘ups and downs’ and encouraged me over the last four years. Most specifically (in alphabetical order) Gemma, Ingrid, Jill, Rachel, Ruth, Sue ii and Zoe. Also, Nicola, Ashleigh, Steve and the rest of North Leeds Dance Academy, for helping me win my first competition during the most difficult stage of my PhD and showing an interest, week on week, by asking ‘Isn’t it done yet?’. I must also thank Jan who has been with me every step of my journey. I appreciate everything you do for me. To Oz, for always believing in me and teaching me that ‘Verily, after hardship comes ease’ (Quran 94:5), which I have used as my mantra throughout. To Chris, for being patient, caring for me and providing excellent company, friendship and meals when they were most needed. To my Mum for painstakingly proof reading (especially my references), my Dad for just being ‘Dad’ and my little sister Sarah, I love you all lots. Lastly, to Grandma for providing my brains and Grandad, my biggest champion; this is for you. iii TABLE OF CONTENTS VOLUME 1 Abstract ................................................................................................................ I Acknowledgements ............................................................................................. ii Table of Figures ................................................................................................ xii Table of Tables ................................................................................................ xiv Glossary of Terms ............................................................................................xvii Abbreviations .................................................................................................. xxv CHAPTER 1 INTRODUCTION ........................................................................... 1 1.1 Background ............................................................................................ 1 1.2 Patient Safety ......................................................................................... 2 1.2.1 Human factors ............................................................................. 4 1.3 Medication Safety ................................................................................... 7 1.4 Medicines Reconciliation ...................................................................... 8 1.4.1 Measuring error associated with medicines reconciliation ........... 10 1.5 Rationale for this Study ....................................................................... 13 1.6 Thesis Outline ...................................................................................... 16 CHAPTER 2 LITERATURE REVIEW ............................................................... 18 2.1 Background .......................................................................................... 18 2.2 Methods ................................................................................................ 18 Findings ................................................................................................ 21 2.3 Part 1 - Definition, Scale and Severity of Discrepancies Found ...... 22 2.3.1 UK and international context ....................................................... 22 2.3.2 Definition of medicines reconciliation .......................................... 25 2.3.3 Models of medicines reconciliation .............................................. 30 2.3.4 Classification of medicines reconciliation-related error ................ 33 2.3.5 Scale of medication discrepancies at transitions ......................... 33 2.3.6 Severity of ADEs and pADEs related to medicines reconciliation35 2.3.7 Risk factors for experiencing medication discrepancy at transition points ........................................................................................... 35 2.3.8 Time taken to complete medicines reconciliation ........................ 39 iv 2.3.9 Sources of information used during medicines reconciliation .... 39 2.3.10 Impact of
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