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Custom and practice: A multi-center study of medicines reconciliation following admission in four acute hospitals in the UKUrban, Rachel L., Armitage, Gerry R., Morgan, Julie D., Marshall, Kay M., Blenkinsopp, Alison, Scally, Andy J. January 2014 (has links)
No / Many studies have highlighted the problems associated with different aspects of medicines reconciliation (MR). These have been followed by numerous recommendations of good practice shown in published studies to decrease error; however, there is little to suggest that practice has significantly changed. The study reported here was conducted to review local medicines reconciliation practice and compare it to data within previously published evidence.
To determine current medicines reconciliation practice in four acute hospitals (A–D) in one region of the United Kingdom and compare it to published best practices.
Quantitative data on key indicators were collected prospectively from medical wards in the four hospitals using a proforma compiled from existing literature and previous, validated audits. Data were collected on: i) time between admission and MR being undertaken; ii) time to conduct MR; iii) number and type of sources used to ascertain current medication; and iv) number, type and potential severity of unintended discrepancies. The potential severity of the discrepancies was retrospectively dually rated in 10% of the sample using a professional panel.
Of the 250 charts reviewed (54 Hospital A, 61 Hospital B, 69 Hospital C, 66 Hospital D), 37.6% (92/245) of patients experienced at least one discrepancy on their drug chart, with the majority of these being omissions (237/413, 57.1%). A total of 413 discrepancies were discovered, an overall mean of 1.69 (413/245) discrepancies per patient. The number of sources used to reconcile medicines varied with 36.8% (91/247) only using one source of information and the patient being used as a source in less than half of all medicines reconciliations (45.7%, 113/247). In three out of the four hospitals the discrepancies were most frequently categorized as potentially requiring increased monitoring or intervention.
This study shows higher rates of unintended discrepancies per patient than those in previous studies, with omission being the most frequently occurring type of discrepancy. None of the four centers adhered to current UK guidance on medicines reconciliation. All four centers demonstrated a strong reliance on General Practitioner (GP)-based sources. A minority of discrepancies had the potential to cause injury to patients and to increase utilization of health care resources. There is a need to review current practice and procedures at transitions in care to improve the accuracy of medication history-taking at admission by doctors and to encourage pharmacy staff to use an increased number of sources to validate the medication history. Although early research indicates that safety can be improved through patient involvement, this study found that patients were not involved in the majority of reconciliation encounters.
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Medicines reconciliation : roles and process : an examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United KingdomUrban, Rachel Louise January 2014 (has links)
Medication safety and improving communication at care transitions are an international priority. There is vast evidence on the scale of error associated with medicines reconciliation and some evidence of successful interventions to improve reconciliation. However, there is insufficient evidence on the factors that contribute towards medication error at transitions, or the roles of those involved. This thesis examined current UK medicines reconciliation practice within primary and secondary care, and the role of HCPs and patients. Using a mixed-method, multi-centre design, the type and severity of discrepancies at admission to hospital were established and staff undertaking medicines reconciliation across secondary and primary care were observed, using evidence-informed framework, based on a narrative literature review. The overall processes used to reconcile medicines were similar; however, there was considerable inter and intra-organisational variation within primary and secondary care practice. Patients were not routinely involved in discussions about their medication, despite their capacity to do so. Various human factors in reconciliation-related errors were apparent; predominantly inadequate communication, individual factors e.g. variation in approach by HCP, and patient factors e.g. lack of capacity. Areas of good practice which could reduce medicines reconciliation-related errors/discrepancies were identified. There is a need for increased consistency and standardisation of medicines reconciliationrelated policy, procedures and documentation, alongside communication optimisation. This could be achieved through a standardised definition and taxonomy of error, the development of a medicines reconciliation quality assessment framework, increased undergraduate and post-graduate education, improved patient engagement, better utilisation of information technology and improved safety culture.
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Medicines Reconciliation: Roles and Process. An examination of the medicines reconciliation process and the involvement of patients and healthcare professionals across a regional healthcare economy, within the United Kingdom.Urban, Rachel L. January 2014 (has links)
Medication safety and improving communication at care transitions are an
international priority. There is vast evidence on the scale of error associated
with medicines reconciliation and some evidence of successful interventions to
improve reconciliation. However, there is insufficient evidence on the factors
that contribute towards medication error at transitions, or the roles of those
involved. This thesis examined current UK medicines reconciliation practice
within primary and secondary care, and the role of HCPs and patients. Using a
mixed-method, multi-centre design, the type and severity of discrepancies at
admission to hospital were established and staff undertaking medicines
reconciliation across secondary and primary care were observed, using
evidence-informed framework, based on a narrative literature review.
The overall processes used to reconcile medicines were similar; however, there
was considerable inter and intra-organisational variation within primary and
secondary care practice. Patients were not routinely involved in discussions
about their medication, despite their capacity to do so. Various human factors
in reconciliation-related errors were apparent; predominantly inadequate
communication, individual factors e.g. variation in approach by HCP, and
patient factors e.g. lack of capacity. Areas of good practice which could reduce
medicines reconciliation-related errors/discrepancies were identified. There is a
need for increased consistency and standardisation of medicines reconciliationrelated
policy, procedures and documentation, alongside communication
optimisation. This could be achieved through a standardised definition and
taxonomy of error, the development of a medicines reconciliation quality
assessment framework, increased undergraduate and post-graduate education,
improved patient engagement, better utilisation of information technology and
improved safety culture.
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