Background Medicines Reconciliation ensures that medicines prescribed on patient admission correspond to those taken before admission. This process involves discussion with patients/carers/using primary care records.

Medicines errors cause harm to patients, lead to increased morbidity/mortality/inflated healthcare costs [1, 2]

NBT has invested in many safety initiatives including: the Safer Patients Initiative (SPI2) and the Southwest Quality and Patient Safety Improvement Programme (SWQPSI).

Purpose To implement and improve Medicines Reconciliation. The objectives were to: Ensure more than 95% of patients admitted receive Medicines Reconciliation within 24 hours; Improve the quality of Medicines Reconciliation and reduce medicines errors on admission.

Materials and Methods Using improvement methodology, tests of change were trialled and spread, involving:

• Phase 1: 2007–2008: (1–8 wards)

  • Introduced a Medicines Admissions Proforma

  • Developed an e-audit tool

• Phase 2: 2008–2009: (8–11 wards)

  • Training DVD was designed

  • Analysed admissions data to spread towards where admissions were >2% of the total number of admissions

  • Collected randomised data electronically as a run chart

  • Improved communication (Patients/Ambulance/GP’s)

• Phase 3: 2009–now: (11–30 wards)

  • 2010: tests of change on accuracy of Medicines Reconciliation, spreading to 42 wards

  • 2012: Surgical Pharmacist funding agreed following a Pre-admissions clinic trial.

Results The medians in the table show improvements 2007–2012. In 2011 we achieved and maintained our target. Accuracy data showed only 55% of admissions drug histories taken by doctors alone are accurate.

Conclusions From February 2011 we achieved and maintained our 95% target on 30 wards. We improved the quality of medicines reconciliation and reduced medicines errors on admission.

The Institute for Healthcare Improvement congratulated us and QIPP’s national programme benchmarking teaching hospitals also highlights our remarkable results.

References

1. National Institute for Health and Clinical Excellence/National Patient Safety Agency: Medicines Reconciliation guidance

2. Quality, Innovation, Productivity and Prevention (QIPP) including Medicines Optimisation and Transfer of Care

No conflict of interest.