MedicineReconciliation

Network

Pamela Mills

Principal Pharmacist – Redesign

SPSP Fellow

Vice Chair Medicine Reconciliation Network

Scottish Patient Safety Programme

• Rolled out to all Acute hospitals in 2008• 5 key workstreams

– Leadership– Critical Care– General Ward– Peri-operative– Medicines Management

Reduce mortality by 15%Reduce adverse events by 30%

Medicine Reconciliation

3 Key Stages– Admission– Transfer– Discharge

Measure: 95% within 24 hours

Reconciliation

• Acute Adult

• Paediatric

• Mental Health 2012

• Primary Care 2012

Medicine Reconciliation Network

• Multiprofessional reference network– Synergy and support– Sharing of best practice and wicked problems– Testing new ideas– Looking for solutions to share

Established Sept 2011

Challenges

• Multiple professions involved• Information available• Time to complete accurately• Admission rates• Prescribing errors• Transcription/ duplication• Scotland and rest of world

Patient Entry Routes

GP Referral

Self Present

999 Ambulance

ADOC

NHS 24

Pre-op clinic

Medicine Reconciliation Process

Medication historyMedicine

ReconciliationInpatient

prescription sheet

Emergency Care Summary (ECS)

July August September October November December January February March April May June35

40

45

50

55

60

65

70

75

80

85

average number emergency admissions per day

2011-2012

2010-2011

2009-2010

2008-2009

2007-2008

2006-2007

2005-2006

2004-2005

2003-2004

2002-2003

2001-2002

2000-2001

1999-2000

1998-9

ECS Med Rec Report

Challenges

• Med Rec report not “user friendly”

• Not consistent process – access & printing

• Accuracy of information

• Certain medicines not included

Redesign of ECS Report

• Patient Name, CHI, DOB • Patient name on all pages• Allergies• Medicines in alphabetical order• Remove dressings, catheters, needles etc• Comments column• Space under each row- changes• 10 empty rows at bottom• Compliance aid• Details of completion

Scotland Consultation

Health Board Agreement?

Ayrshire and Arran Yes

Borders Yes

Dumfries & Galloway N/A

Fife Yes

Golden Jubilee N/A

Grampian Yes

Greater Glasgow & Clyde Yes

Highlands Yes

Lanarkshire Yes

Lothian Yes

Orkney N/A

Shetland N/A

Tayside Yes

Western Isles N/A

24 Yes

Feasibility?

• Patient name on all pages - 02/11/11

• Alphabetical order- local filter

• Remove non-drugs- not possible

• Everything else – March 2012