Medicines Reconciliation

All interfaces in care represent risk to the patient. Hospitals have made significant progress in targeting pharmacists to check medicines as soon after admission as possible. GPs have made some progress in supporting this process with green bag and yellow folder schemes, but these are not always used. There is also some issues with the referral letters, particularly discussing medicines that are to be discontinued before discharge.

PCTs have driven hospitals to improve the quality of discharge letters. The timeliness and quality of these still need work to improve care and reduce the chance of read mission. In particular clarity about discontinued medicines and the indication and duration of initiated medicines including information about titration if required.

Looking at medicines reconciliation in primary care, this needs urgent attention. In the recent CQC report less than 8% of GPs were aware of a PCT policy. Less than half of the PCTs had a policy and less than half of the GP practices had their own. None of the PCTs visited by the CQC were able to demonstrate that medicines reconciliation in general practice was either timely or accurate.

An average GP practice would have up to 6 discharges a day and several letters from out-patients. It is important for these to be reviewed, tests ordered, clinical system updated, medicines changed and patients risk stratified and sent invitations to see the GP/nurse/practice pharmacist if required. Automatic contact with patients post discharge may improve outcomes and facilitate better medicines experience. In my own research within an acute cardiac ward, over 60% of medicines were discontinued on admission. 40% of initiated medicines were discontinued before discharge and 30% of discharge medicines were changed within 30 days.

Medicines reconciliation in general practice to too important to ignore. A systematic approach would support the use of practice based medicines optimisation specialists to drive reconciliation as part of their work to improve outcomes, reduce referrals, reduce admissions and reduce waste.


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