Quality statement 4: Medicines reconciliation in acute settings

Quality statement

People who are inpatients in an acute setting have a reconciled list of their medicines within 24 hours of admission.

Rationale

Medicines-related patient safety incidents are more likely when medicines reconciliation happens more than 24 hours after a person is admitted to an acute setting. Undertaking medicines reconciliation within 24 hours of admission to an acute setting (or sooner if clinically necessary) enables early action to be taken when discrepancies between lists of medicines are identified.

Quality measures

Structure

Evidence of local arrangements to ensure that people who are inpatients in an acute setting have a reconciled list of their medicines within 24 hours of admission.

Data source: Local data collection and Medicines optimisation dashboard.

Process

Proportion of people who are inpatients in an acute setting who have a reconciled list of their medicines within 24 hours of admission.

Numerator – the number in the denominator who have a reconciled list of their medicines within 24 hours of admission.

Denominator – the number of people who are inpatients in an acute setting.

Data source: Local data collection.

Outcome

a) Harm attributable to errors in medication following acute inpatient admission.

Data source: Local data collection.

b) Patient satisfaction with outcomes from the use of medicines.

Data source: Local data collection.

c) Number of patient complaints relating to medication issues.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as secondary care and mental health providers) ensure that systems are in place for people who are inpatients in an acute setting, to have a reconciled list of their medicines within 24 hours of admission.

Healthcare professionals (such as doctors, nurses, pharmacists and pharmacist technicians) ensure that they reconcile a list of medicines for people who are inpatients in an acute setting within 24 hours of admission (or sooner if clinically necessary).

Commissioners (such as clinical commissioning groups and NHS England) ensure that they commission acute services that reconcile a list of medicines for people who are inpatients in an acute setting within 24 hours of admission.

What the quality statement means for patients, service users and carers

People who go into hospital as inpatients have an up‑to‑date list of their medicines in their hospital record within 24 hours. They may be involved in this process if they wish to be. This ensures that any mistakes with their medicines are quickly noticed and sorted out.

Source guidance

Definitions of terms used in this quality statement

Acute care settings

Acute care settings include secondary care, tertiary care and mental health services.

[Expert opinion]

Reconciled list

Medicines reconciliation is the process of identifying an accurate list of a person's current medicines and comparing it with the current list in use. The information can be obtained from a variety of sources such as: medication brought to hospital by the patient, GP surgery patient records, repeat prescription slips, hospital case notes, community pharmacy patient medication records and care home medicines administration record. The list should include name, dosage, frequency and route of administration. Any discrepancies should be identified and any changes documented. The result is a complete list of medicines, accurately communicated to all health and social care professionals involved in the person's care, in which any issues with the medicines, such as wrong dosage or omission, have been addressed.

[Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes (2015) NICE guideline NG5 and expert opinion]

Within 24 hours of admission

Medicines reconciliation for people who are inpatients in an acute setting should occur within 24 hours of admission, regardless of the time of admission or the day of the week.

[Expert opinion]

Equality and diversity considerations

Healthcare professionals should recognise that people's ability to understand the issue of medicines reconciliation may differ, and take this into account in discussions with the person. Some people may need additional support to understand the issue, for example, if English is not their first language or if they have communication or sensory difficulties.