HPE HPE 85 – Spring 2017 - Page 29

Pharmacy practice Issue 85 | Spring 2017 24 hours medicines reconciliation in hospital Why the UK government recommendation for patients admitted to hospital to receive medicines reconciliation from a pharmacist is poorly evidence-based, both with respect to the 24-hour requirement and the need to see all patients is discussed David Wright BPharm (Hons) PGCHE PhD Professor of Pharmacy Practice University of East Anglia, UK Brit Cadman MPharmS MFRPSII Consultant Pharmacist and Principal Investigator Cambridge University Hospital, UK Medical information systems within different care settings are unable to communicate with each other. This has resulted in the need for medici nes reconciliation (MR) when patients are admitted to and discharged from hospital. MR is defined by the World Health Organization as ‘the formal process in which healthcare professionals partner with patients to ensure accurate and complete medication information transfer at the interfaces of care’ 1 MR has become a central responsibility for pharmacy departments in secondary care settings 2 and increasingly in primary care. 3 Reliance on a single healthcare professional to take a full medication history at the same time point as providing a physical examination and developing a preliminary diagnosis has been found to result in unintentional errors rates of between 30% and 70% relating to hospital prescriptions on admission. 4–9 The omission of medicines prescribed in primary care, prescription of incorrect dosages and addition of medicines which have not been previously prescribed have all been shown to occur. This is known to contribute to patient morbidity and mortality and increase the length of hospital stay. 10–14 In the UK in 2007, patient safety guidance issued by the National Patient Safety Agency (NPSA) and the National Institute for Health and Care Excellence (NICE) recommended that policies for MR should be implemented in hospitals for all adult patient admissions. Part of this recommendation is that pharmacy should be involved in the MR process within 24 hours of admission. 15 While the evidence for the recommendation to use pharmacists in the process has built over time, 2,4,16–19 the rationale for it to occur within 24 hours is not underpinned in the same manner. While the length of stay within secondary care continues to reduce to a current overall average of less than two days in the UK, 20 it would seem appropriate for MR to occur within 24 hours. Delaying MR beyond 24 hours in most acute admissions may reduce the chances of it occurring at all during a patients hospital stay. Furthermore, the longer the delay, the greater the likelihood of patients being harmed due to any prescribing errors. It should however, also be considered that the majority of those patients, who are admitted and discharged in less than two days, are more likely to use their own medicines during admission and less likely to experience significant changes in long term medication. They are also less likely to be prescribed large numbers of medicines and less likely to require pharmacist intervention. 21 The 24-hour requirement creates difficulties for pharmacy departments that have traditionally worked from hospitalpharmacyeurope.com 27