11th November 2009
In October 2009 the results from the study ‘Medicines reconciliation in ambulatory care: attempts at improvement’1 were published. The objective of the study was to improve the overall accuracy of medication lists in an outpatient setting by providing performance feedback and training to the healthcare team and increasing patient participation in the medication reconciliation process. The study was carried out in outpatient clinics in Rochester, U.S.A.
The authors of the study focused on medicine list completeness, correctness and accuracy using a random selection of patients for each of the 3 separate measurement periods: pre-intervention (n=108), and 2 immediate post interventions — firstly a licensed practical nurse (LPN) intervention (n=102), followed by a patient awareness intervention (n=115). The study aimed to test the authors’ hypothesis that medication list accuracy would improve by including patients in the process. The results were:
- Completeness of medication lists improved from 20.4% pre-intervention, to 45.1% post LPN intervention, and 50.4% following the patient awareness intervention
- Correctness of medication lists improved from 23.1% post LPN intervention, to 37.7% following the patient intervention.
- The medication list accuracy improved from 11.5% pre-intervention, to 19.2% post LPN intervention, and 29.0% following the patient intervention.1
Medicines reconciliation is as important in the outpatient setting as it is during the admission or discharge stages of an inpatient episode.
The authors of this study have demonstrated that, by involving and training all members of the healthcare team, providing performance feedback and increasing patient involvement in the process, the accuracy of medication lists in outpatient settings can be significantly improved.
Outpatient healthcare teams should review their procedures to ensure that they are doing all they can to train their staff and encourage patient involvement in the medicines reconciliation process.
Medication error can result in harm to patients. The NPSA reported the number of incidents of medication errors involving admission and discharge as 7070, with 2 fatalities and 30 that caused severe harm (figures from November 2003 and March 2007).2
It is important that healthcare professionals and managers from different care settings agree on a minimum dataset of information to support the medicines reconciliation process. Once that has been agreed, all staff involved in a patient’s transfer of care should work together to make sure that this information is effectively communicated across all care interfaces. Involving the patient in this process will lead to further improvements to the accuracy and completeness of information.
How does this relate to other publications or evidence?
In October 2009 the Care Quality Commission (CQC) produced its review ‘Managing patients’ medicines after discharge’3 which shows how, to prevent harm to patients from medicines, the NHS needs to improve the sharing of vital information when people move between services. In this review the CQC makes several recommendations for organisations to ensure that care becomes safer for patients.
The CQC review supports the recommendations from the NPSA and NICE in December 2007 ‘Technical patient safety solutions for medicines reconciliation on admission of adults to hospital’4 on the need for healthcare organisations to put policies in place to support the process of medicines reconciliation.
In addition to these recommendations, the NPC 2008 guide – Medicines Reconciliation: A Guide to Implementation, gives hints and tips on the practical aspects of the medicines reconciliation process. The guide suggests minimum datasets needed to enable medicines reconciliation to take place; discusses the reliability of information sources that are available to healthcare professionals trying to reconcile lists of medicines; and proposes key skills that are needed to carry out the reconciliation process.
There is an NPC section dedicated to Medicines Reconciliation which includes a range of resources that can help busy healthcare professionals to learn about the topic in small, bite-sized chunks. The NPC section, Improving safety & managing risk, also provides information, tools and resources which can support effective medicines reconciliation.
1. Nassaralla CL, Naessens JM, Hunt VL, Bhagra A, Chaudhry R, Hansen MA, Tulledge-Scheitel SM. Medicines reconciliation in ambulatory care: attempts at improvement. Quality and Safety in Health Care 2009;18: 402-407.
2. NPSA (2007). ‘NICE/NPSA issues its first patient safety solution guidance to improve medicines reconciliation at hospital admission’ [Last accessed 9th November 2009].
3. Care Quality Commission national report. Managing patients’ medicines after discharge from hospital. Care Quality Commission, 2009
4. NPSA and NICE (2007). ‘Technical patient safety solutions for medicines reconciliation on admission of adults to hospital’ [Last accessed 9th November 2009].