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Medicines Reconciliation Protocol

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Medicines Reconciliation Protocol Medicines Reconciliation Protocol Version 2 RATIFYING COMMITTEE Drugs and Therapeutics Group DATE RATIFIED May 2021 NEXT REVIEW DATE May 2024 EXECUTIVE SPONSOR Chief Medical Officer POLICY AUTHORS Principal Pharmacists Deputy Chief Pharmacist Specialist Pharmacy Technicians Executive Summary: • This protocol outlines the requirements and process relating to medicines reconciliation within the Trust. • Includes staffing skill mix, information sources to be used and documentation standards. • Identifies specific areas and medicines to be given further consideration. If you require this document in an alternative format, i.e. easy read, large text, audio, Braille or a community language please contact the pharmacy team on 01243 623349 (Text Relay calls welcome) CONTENTS Page 1. Introduction 3 2. Scope 3 3. Definition 3 4. Duties and responsibilities 4-5 5. Medicines reconciliation process 6-9 6. Standards 11 7. Training 11 8. Monitoring compliance 11 Appendix 1 Medicines reconciliation template 12 Appendix 2 Medicines reconciliation flowchart 13 Appendix 3 Summary Care Record (SCR) process 14 Appendix 4 Summary Care Record (SCR) flowchart 15 Page 2 of 14 1. Introduction 1.1. Medicines reconciliation (MR) is the process by which medicines prescribed for patients on admission, corresponds to the medicines they were taking before admission, unless there is clear clinical justification for changing or discontinuing a medicine. 1.2. Historically, medicines reconciliation was performed by junior doctors on admission as part of the clerking process. In 2007, NICE and NPSA issued joint guidance highlighting the risks associated with medication prescribed on admission, with an unintentional error rate of 30-70% reported. POMH-UK shows that the Trust’s doctors undertake a drug history in 84% of patients but only find 4% discrepancies in those patients. 1.3. The guidance advised that pharmacy staff involvement in the medicines reconciliation process was associated with reduction in errors on admission, and advised that pharmacy staff should be involved with the medicines reconciliation process on admission to inpatient services as soon as possible, and ideally within 24 hours to acute services. 1.4. The medicines reconciliation process therefore aims to reduce the risk of harm to patients and reduce the risk to the Trust in terms of litigation and prolonged length of stay. 2. Scope 2.1. This protocol applies to all patients admitted to the Trust’s inpatient services, covering working age adult, secure and forensic, rehabilitation, learning disabilities, older people’s and young people’s services. If medicines reconciliation is carried out in the Crisis Resolution and Home Treatment (CRHT) team then this procedure applies 2.2. This protocol applies to all qualified medical, nursing, pharmacist and pharmacy technician staff, providing care to inpatients of Sussex Partnership NHS Foundation Trust. 2.3. This protocol should be read with reference to the Trust’s Medicines Code. 3. Definition 3.1. Medicines reconciliation is a process designed to ensure that all medicines that a patient is currently taking prior to admission is accurately recorded, documented and prescribed if still needed at point of admission and transfer. It includes: 3.1.1. Collecting information relating to medicines taken prior to admission, using the most recent and accurate sources of information to create a full and current list of medicines, including prescribed, over the counter, herbal and homeopathic medicines. 3.1.2. Checking that the medicines prescribed on admission are appropriate for the patient, and ensuring any discrepancies are documented, and actioned as necessary. 3.1.3. Communicating, through appropriate documentation, a full list of reconciled medicines. Including any changes, omissions and/or discrepancies. Page 3 of 14 4. Duties and responsibilities 4.1. Medical Staff are responsible for: 4.1.1. Performing level one medicines reconciliation for patients admitted to the Trust, in line with the Trust protocol (see section 5.4). 4.1.2. Undertaking medicines reconciliation as soon as possible after patient admission, ideally as part of the clerking process, but within 24 hours of admission. 4.1.3. Clearly documenting if unable to complete medicines reconciliation, including the reasons and any further follow up actions. 4.1.4. Using appropriate sources of information. i.e. to use one, but ideally two information sources (refer to section 5). 4.1.5. Prescribing medicines in accordance with the medicines reconciliation process. 4.1.6. Documenting the patient’s allergy status on the drug chart and in carenotes, and recording allergy status as a clinical alert within carenotes. 4.1.7. Documenting the patient’s medicines list, sources used, and any medication changes (including reasons) within the patient’s carenotes record. To record under assessment tab. 4.1.8. Documenting and planning for any further measures required, for example: blood tests, unknown allergy status to be verified. 4.1.9. Acting on any further identified discrepancies as a priority. These may be communicated verbally or through the patient’s drug chart. 4.1.10. Document any alerts including allergies and vaccines (e.g. covid-19 vaccine, date, type and 1st/2nd dose) on care notes within the demographics and then alert section of carenotes. 4.2. Nursing Staff are responsible for: 4.2.1. The accurate and safe administration of medicines in accordance with the Trust’s Medicines Code and the Nursing and Midwifery Council (NMC) guidelines. 4.2.2. Reporting incidents. 4.2.3. Before administration of medicines ensuring that the allergy status is checked. 4.2.4. Supporting medical and pharmacy staff in undertaking medicines reconciliation, where appropriate, including accessing the patient’s Summary Care Record (appendices 3 and 4) or requesting a general practitioner (GP) summary and information 4.2.5. Document any alerts including allergies and vaccines (e.g. covid-19 vaccine, date, type and 1st/2nd dose) on care notes within the demographics and then alert section of carenotes. 4.3. Pharmacy Staff are responsible for: 4.3.1. Undertaking level two medicines reconciliation for patients admitted to the Trust, in line with this Trust protocol (see section 5.4). Page 4 of 14 4.3.2. Undertaking the medicines reconciliation process as soon as possible after patient admission, ideally as part of clerking process, but within one full working day after admission. 4.3.3. Using at least two sources of information when undertaking medicines reconciliation (refer to section 5.2). 4.3.4. Documenting the medicines reconciled on the Trust approved template (see appendix 1) or electronic form on carenotes (when available). Ensuring sources used, full medicines list and allergy status are all recorded. This information should be typed. If unable to type, it must be completed in block capitals, and it must be legible and clear, using as many sheets as needed. 4.3.5. Uploading the approved template within 24hours in the “medication” tab of carenotes. 4.3.6. Ensuring medicines reconciliation and any outstanding actions are communicated and documented (in the patient’s notes and on their drug chart). 4.3.7. Document any alerts including allergies and vaccines (e.g. covid-19 vaccine, date, type and 1st/2nd dose) on care notes within the demographics and then alert section of carenotes. 4.3.8. Ensuring all discrepancies are recorded and communicated to the ward medical and nursing staff, including any agreed action plan. 4.3.9. Providing training on medicines reconciliation to ward and pharmacy staff where appropriate. 4.3.10. Undertaking Trust audit and providing assurance around quality and compliance to medicines reconciliation standards. 5. Medicines reconciliation process 5.1. Medicines reconciliation is the responsibility of all staff involved with the admission, prescribing, monitoring, administration, transfer and discharge of patients requiring medicines. It is a requirement to ensure that the drug chart is accurate as soon as possible after admission or transfer, to minimise the risk of harm to patients. 5.2. See appendix 2: medicines reconciliation process flowchart. 5.3. Collecting and checking information 5.3.1. Information relating to the patient’s medicines should be initially obtained from the patient (and/or carer) and collaborated (ideally) by at least two additional sources (as detailed below). 5.3.2. It should not be assumed that the medicines history documented in the admission notes or initial drug chart is accurate. These should be used as a guide only, as there can be errors with doses, formulations, product choice, omissions or discontinued medicines etc. 5.3.3. Patient consultation: Whenever possible, the patient should be the first source of information alongside the patient’s current drug chart and notes. An interpreter should be used where appropriate. A carer can also be asked if the patient is unavailable or unable to communicate information on their medicines. Page 5 of 14 The following checklist can be used to aid the process. 5.3.4. Ensure patient consultation and/or discussion relating to medicines is fully documented within carenotes. Introduce yourself to patient/carer and explain what you are doing. Confirm patient identity (photo / name / date of birth). Clarify patient allergy status, including nature and severity of allergies. Document allergy status on the drug chart and in carenotes. Ask what medicines they are currently prescribed by their GP, including names, strength, dose and frequency. Confirm with GP repeat or prescription form if available. Ask if they have brought any medicines in with them, or if there is a relative that can bring all their supplies of medicines from their home. Ask if they ever forget to take their medicines as prescribed, or if they have changed or stopped anything. Ask if they are prescribed or given medicines by anyone else other than their GP, (eg. SMS sexual health, depot clinics). Ask if they buy any medicines over the counter or use any herbal or complementary medicines.
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