Good Practice Guidance RECONCILIATION

WHAT IS MEDICINES If a resident’s is not RECONCILIATION accurately listed: • The resident might receive the wrong Medicines reconciliation is the process dose, strength, or formulation of of identifying an accurate list of the their . • actual medicines a person is taking and The resident may not receive their comparing it with the current list in use. medicine at all. • There could be delays to a resident’s Medicines reconciliation should be treatment while issues are resolved. • completed in a timely manner for all Greater risk of drug interactions and new residents; those recently adverse effects. • discharged from and when Additional staff time spent on transferred between care settings resolving issues. • (including from home). could order in the wrong medication for a resident.

IMPORTANCE OF MEDICINES WHO CAN COMPLETE MEDICINES RECONCILIATION RECONCILIATION This can be carried out by any member of When people transfer between different staff who has been trained in medicines care providers, such as at the time of management and is competent in hospital admission or discharge, there is medicines administration and has the a greater risk of poor communication and necessary information to complete the unintended changes to medicines. When process in a timely manner. It is people move from one care setting to important to establish who has another, between 30% and 70% of responsibility for the process. patients have an error or unintentional change to their medicines1 It is also important to involve: • The resident and/or their family An ‘up to date’ copy of the resident’s members or carers repeat list must be kept in a safe place in • A case of emergency admission. • Other health and social care practitioners involved in managing medicines for the resident, as agreed locally. November Good Practice Guidance documents are believed to accurately reflect the literature at the time of writing. However, users should always consult the literature and take 2020 account of new developments because these may affect this guidance. Developed for care home staff. May be of relevance to staff in other settings. MEDICINES RECONCILIATION PROCESS

1) Check 2) Clarify 3) Communicate 4) Record 5) Remember

Check Following information to be checked in a timely manner during admission/transfer to a care home:  How/when resident prefers to take their medicine. Include an assessment for self-administration.  Resident’s details (full name, date of birth, NHS number, address and weight (where appropriate e.g. frail residents).  GP's details.  Details of other relevant contacts identified by the resident and/or their family members or carers (e.g. consultant, regular pharmacy, specialist nurse).  Known allergies and reactions to medicines or ingredients and the type of reaction experienced.  Medicines the resident is currently taking, including name, strength, form, dose, timing and frequency, how the medicine is taken (route of administration) and what the medication is for (indication), if known. Include any medicines purchased over-the-counter or complementary medicines.  Record indication for “when required” medicines.  Information about any medicine given less often than once a day (weekly or monthly medicines) or medicine not prescribed by the GP (e.g. hospital outpatient or mental health clinic).

The most up to date reliable source should be used, crossed checked and verified. Sources of Information:  A computer print-out from a GP clinical system.  The tear-off side of a resident’s repeat prescription request.  Verbal information from the resident, their family, or a carer.  Medical notes from a resident's previous admission to hospital (e.g. discharge summary).  Medicine containers available at the time of reconciliation.

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Clarify Clarify the following: • Changes to medicines and reason(s) for change. Include medicines started, stopped or dose changes. • Date and time of last dose of any 'when required' medicine. Include specific instructions to support administration. • Other information, including when the medicine should be reviewed or monitored, and any support the resident needs to carry on taking the medicine. • Resolve any discrepancies. • Check that there are no new changes (e.g. new adverse effects or resident's ability to swallow tablets).

If a discharge summary appears incomplete, inaccurate or ambiguous, action must be taken immediately to seek clarification to avoid potential harm to the resident.

For further support, please contact your community or practice/PCN pharmacist

Communicate Document, date and communicate any changes to staff responsible for the resident’s care, particularly: • New or discontinued medicines. • Changes in medicine strength, dose or frequency of administration. • Length of treatment; increasing or reducing dose regimens. • Care with brand and generic names of the same medicine. • New allergies.

Any changes to must be communicated to the community pharmacy provider in a timely manner Record • Ensure that the details of the person completing the list of resident's medicines (name, job title) and the date are recorded. • Record what information has been given to the resident and/or family members or carers.

Remember Remember the 6 R’s: Right Person Right Dose Right Route Right Medicine Right Time Right to Refuse 3 Useful contacts East and North Hertfordshire CCG Care Home Pharmacy Team Tel: (01707) 685000 or email: [email protected]

MEDICINES POLICY Care home medicines policy should have a written process for medicines reconciliation and include organisational responsibilities; responsibilities of staff involved in the process; who they are accountable to; individual training and competency needs; resources needed to ensure that medicines reconciliation occurs in a timely manner as well as a robust process for addressing discrepancies.

It is recommended that the process is reviewed regularly including if any adverse incidents or complaints occur relating to the process; if there are any changes in responsibilities, scope or purpose identified or if any new national or local evidence emerges that requires a change in the process.

For further information, refer to the NICE checklist for care home medicines policy May 2014: https://www.nice.org.uk/guidance/sc1/resources/checklist-for-care- home-medicines-policy-pdf-13716829

ACKNOWLEDGEMENT With thanks to NHS Devon CCG’s Caring for Care Home Team for local adaptation of ‘Guidance sheet 15: Accurately listing a resident’s medicines (medicines reconciliation)’

REFERENCES / SUPPORTING INFORMATION 1) NICE Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes [NG5] Published date: 04 March 2015: https://www.nice.org.uk/guidance/ng5 2) NICE Managing medicines in care homes Social care guideline [SC1] Published date: 14 March 2014: https://www.nice.org.uk/guidance/sc1

3) CQC Guidance for Providers: Medicines reconciliation and medication review https://www.cqc.org.uk/guidance-providers/adult-social-care/medicines-reconciliation- medication-review 4) All Wales Medicines Strategy Group, All Wales Multidisciplinary Medicines Reconciliation Policy. June 2017 5) PrescQIPP Bulletin 112: Care homes: Good practice guide to prescribing and medication reviews. October 2015

Version 1.1 Developed by Care Home Pharmacy Team, Pharmacy and Medicines Optimisation Team, ENHCCG Date Published Reviewed remotely by Medicines Management Group (PCMMG) membership, ENHCCG; 12/11/2020 To be ratified at next opportunity

Review date 12/11/2022

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