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What are the 2 levels of medicines reconcilliation?

Level 1 --> Obtaining a medication list and documenting it (usually in a drug chart)

- Admission led


Level 2 --> Two or more sources are used to ensure that it is correct, with any discrepencies spotted and sorted out (this is not a clincal screen!)

- Pharmacy consolidation


What are the 3 Cs about in terms of medicines reconcilliations?

Collecting --> Taking a meds history with 2 different sources of information


Checking --> Looking at differences/similarities between the meds history that you have made, with the drugs that are currently prescribed


Communicating --> Document and data any changes that have been made


What type of service is an MUR?

An advanced service


What is the eligibility criteria for an MUR?

Had medication from the pharmacy for at least 3 months


Be part of on an MUR target group (High risk medicine)


Have more than one medication (unless the one medication is high-risk)


Have the capacity to consent to the review


Not had an NMS in 6 months or an MUR in 12 months


Define AKI

A rise in serum creatinine of 26micromol/L or greaer within 48 hours


A 50% or greater rise in serum creatinine in the last 7 days


A fall in urine output to less than 0.5ml/kg/hour for more than 6 hours


What is gestational age for pre-term babies?

The number of weeks gestational age (eg, 25 weeks) plus the number of weeks sincxe birth (eg, 3 weeks)


This would make the age of the baby as 28 weeks (gestational age)


At what period of pregnancy are drugs most dangerous?

3rd to the 11th week (first trimester) as they could cause congenitial malformations


What 4 disease states must be monitored more in pregnancy?





Hypertension (due to pre-eclampsia)


Mental health problems


What are the 4 target groups for an MUR?

Patients on high-risk medications


Patients who have just been discharged from hospital and had their medications altered


Patients with respiratory disease


Patients with CVD (or at risk) and regulalrly being prescribed 4 or more drugs