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Patient safety first

The National Institute for Health and Care Excellence (NICE) and the National Patient Safety Agency (NPSA) have produced recommendations for the NHS on how to reduce the risk of prescribing errors when patients are admitted to, or discharged from, hospital. The aim is to ensure all hospitals have a system in place to minimise the risk of such errors.

Medicines prescribed to a patient in hospital should complement or correspond to those they were taking before admission. However, according to the NPSA, there were 7070 prescribing errors involving patients being admitted or discharged from hospital between November 2003 and March 2007. This led to two fatalities and 30 serious incidents.

The new guidance recommends recording a number of details when a patient is admitted to and discharged from hospital to get a clear picture of the medication they are on. These include: the name of the medicine(s), dosage and frequency and route of administration.

Where necessary, it also recommends discussing the details with the patient and/or carers and using primary care records. NICE is also recommending that pharmacists and their teams should be involved as soon as possible after admission to help cross-check the patient's medication details.

The recommendations are the result of a pilot project run by NICE and the NPSA, as part of a review of patient safety commissioned by the Chief Medical Officer (‘Safety first: a report for patients, clinicians and healthcare managers' [DH 2006]). It involved assessing the evidence on clinical and cost-effectiveness using independent expert committees, public consultation and an open decision-making process.

For details on the recommendations go to: Technical patient safety solutions for medicines reconciliation on admission of adults to hospital

This page was last updated: 24 June 2010

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Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.