Medicine Reconciliation Flashcards
What is Medicines Reconciliation?
Process of obtaining up to date and accurate medication list
that has been compared to most recently available info
and has documented any:
Discrepancies, Changes, Deletions and Additions
resulting in a COMPLETE list of medications, accurately communicated
WHEN should medicine reconciliation occur? (4)
- At the transfer of care between different settings eg. Hospital admission
- Hospital discharge
- Ward/department transfer (movement between settings)
- Entry into residential or nursing homes
WHY do a Medicine Reconciliation (6)
- Reduce prescribing errors
- Reduce hospital admission + readmission due to harm from med
- Reduce no. of missed doses
- Improving quality and timeliness of info available to clinicians, (which improves therapeutic outcomes)
- Increases patient involvement in their care, promoting concordance
- Reducing waste
Aims of Med Rec when patient admitted to hospital (2)
- Ensure important medicines aren’t stopped
- New meds prescribed with complete knowledge of what patient is already taking
How to do a Medicines Reconciliation:
Aka, what are the 3 C’s?
1) Collecting
2) Checking
3) Communicating
a) What does ‘collecting’ (basic reconciliation) entail?
b) What are some important requirements of this process? (3)
a) - Taking a DRUG HISTORY and collecting info about patients meds
- Info can come from a range of sources (reliable?)
b) - Most recent available
- Record DATE of info obtained
- Note the SOURCE of info
What does ‘checking’ entail?
- CRITICAL APPRAISAL of the info to verify that the med and doses are correct AND that there are no duplications
During the checking process, what should you do if there is a discrepancy between what the patient is currently prescribed and what they’re currently taking? (2)
- RECORD the discrepancy
- Give the REASON for the variation (if it can be established)
What does the last C, ‘communication’, involve? (2)
- Could involve making changes to the patient record or prescription
- Communicating the change to the patient
(also needs organisation and communication between other healthcare professionals)
What things do you do (2) or ask (7) when GATHERING INFO on a patient?
- Confirm patient name & DOB/address
- Explain when you’re going to do & why (consent)
- Any allergies + reactions?
- Brought any medications or a list of them?
- Ask how they take each medication
- Ask if they take other meds and how often (eye drops, inhalers, creams etc)
- Do they take any meds bought from pharm/OTC/shop/internet?
- Any illicit/vits/homeopathic/supplements/ smoking/recreational?
- Any recent changes to meds? (stopped/started/dose change?)
What are some sources of information used for a med rec? (10)
- Patient
- Patients own drugs
- Repeat prescriptions
- Relatives/carers
- GP letters and surgery
- Reminder charts/devices
- Discharge summary
- Care home records
- Community Psychiatric Nurse
- DDU (drug dependence unit)?
Reliable information sources (5)
- Computer print-out from GP clinical records system
- Tear-off side of patients repeat prescription
- Verbal info from patient, family or carer
- Medical notes from patients previous hosp admission
- Patients own drugs
Less reliable information sources (4)
Community Pharmacy records
Medicine Administration Record (MAR) sheet
Care plan
Care home manager
For each medication check for: (7)
Name, dose, frequency, formulation, duration, indication and problems
Be aware of allergies/sensitivities and the nature of them
:/
Well… nothing to add here but it could be an S//E rather than an allergy/sensitivity
