Optimising medicine reconciliation at the healthcare interface

��Keywords: Medicine/ medication reconciliation, care transition, pharmacist service, discharge communication, medication discrepancies, health interface Background: Medicine reconciliation (MR) is the process of obtaining and maintaining an accurate, detailed list of all medicines taken by a patient and using this list anywhere within the health care system to ensure that the patient receives the correct medicines. This thesis aimed to design an MR intervention and develop a strategy for its evaluation. Methods: A health Trust-wide evaluation of the quality of discharge information relative to national guidance for the minimum dataset of information transfer was undertaken to identify the areas of sub-optimal practice. A systematic review informed the content and design of a pharmacy led medicines reconciliation service. A pilot randomised controlled trial was conducted to provide an early indication of the intervention’s costs and effects and to inform the design of a definitive trial. Results: A review of 3,444 discharge summaries in one primary care trust found that 80% had at least one medication discrepancy. On average these were considered to cause moderate patient harm and to take 15 minutes to address. No studies were found to comprehensively assess the cost-effectiveness of pharmacy led medicines reconciliation. Interim analysis of a pilot 24 hour MR service showed that only 20% of errors upon admission were intercepted before discharge in the control group, compared to 98.6% within the intervention arm. The MR service was estimated to contribute to cost savings of almost £3,000 per patient. Conclusions: The existing process to transfer and process information at the healthcare interface is not optimum. Evidence to demonstrate the cost-effectiveness of pharmacy led MR services is not currently available. Interim analysis of a pharmacy led 24 hour MR service suggests that the service may enhance accuracy and transfer of information and reduce overall health resource utilisation. The pilot MR service will inform the feasibility of large scale evaluation for the cost-effectiveness.

Name dc:type.qualificationname

phd

Level dc:type.qualificationlevel

doctoral

Grantor dc:publisher.institution

University of East Anglia

Year dc:date.issued

2013

Author dc:creator

• Hammad, Eman

Language dc:language

en