Y1 Clinical Skills Flashcards
(7 cards)
Define Medicines reconcilliations
Medicines reconciliation is defined as:
1. The process of identifying the most accurate list of medications a patient is taking (the drug history)
2. Then comparing this to the list of currently prescribed medications (for example on the hospital drug chart)
3. Identifying discrepancies and ‘reconciling’ all identified issues
Why is medicines reconciliations important?
There is no central NHS patient record
Hospital admission prescriptions carry anerror rate of 30 to 70%
Over 50% hospital medication errors occur at transition of care
Inappropriate prescribing decisions are made if prescriber’s do not have a full, accurate list of a patient’s medication
Where to get information about a patient from?
Patient or relative / carer
Electronic GP care records
Recent GP printout
Recent discharge summary
Repeat prescription
Patient’s own drugs (PODs)
Clinic letters
Community pharmacy
MAR (Medicines Administration Record) sheet
Hospital transfer information
Insulin passports, lithium or warfarin books
Why must a person be included in the use of Drug history?
This is really important, the allergies need to ‘travel’ with the patient through their hospital stay too, so we need to make sure these are accurate, clearly documented to prevent harm from the patient from giving a medicine they are allergic to, or indeed not giving a medicine because of a perceived allergy
Adherence is a complex subject and hard to assess, but essential to medicines being given in primary and secondary care, knowing if a patient is adherent or not will guide what we do next… think back to our patient in the emergency department
Pause to think about what information you may only be able to obtain from a patient
Examples of incomplete GP records; cardiac admission on HRT, specialist medication e.g. chemotherapy
Allergies and nature of reaction
What the patient actually takes
Any problems with side effects/intolerances
Timings of medications prescribed ‘once a day’
With food if patient finds better
Are they crushing medications?
What are the possible special groups of patient characteristics?
Extremes of age; paediatrics, geriatrics
Licensing; safety; how to administer?
Comorbidities, frailty
Pregnant and breastfeeding women
Safety for both pregnant women and foetus/newborn
Extreme of weight; malnourished patients, obese patients
Male or female?
Ethnicity, cultural or religious beliefs
How do comorbidities affect a patient’s treatment?
Consider cautions and contraindications to treatment
Relates to other medicines a patient is taking, past medical history, current medical conditions
Relative contraindication:
Also known as a caution
Acceptable only if benefit outweighs the risk
Absolute contraindication
Potentially life-threatening risk if used in combination
