Quality standard
Quality statement 5: Medicines reconciliation in primary care
Quality statement 5: Medicines reconciliation in primary care
Quality statement
People discharged from a care setting have a reconciled list of their medicines in their GP record within 1 week of the GP practice receiving the information, and before a prescription or new supply of medicines is issued.
Rationale
Medicines-related patient safety incidents are more likely when medicines reconciliation happens more than a week after discharge from a care setting such as a hospital or care home. Undertaking medicines reconciliation in primary care within 1 week of the GP practice receiving the information, and before a prescription or new supply of medicines is issued, allows early action to be taken when discrepancies between lists of medicines are identified. For example, it can prevent people from being prescribed medicines that were stopped while they were in hospital.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence of local arrangements to ensure that people discharged from a care setting have a reconciled list of their medicines in their GP record within 1 week of the GP practice receiving the information.
Data source: Local data collection.
b) Evidence of local arrangements to ensure that people discharged from a care setting are not issued a prescription or new supply of medicines until they have a reconciled list of their medicines in their GP record.
Data source: Local data collection.
Process
a) The proportion of people on medicines discharged from a care setting who have a reconciled list of their medicines within 1 week of the GP practice receiving the information.
Numerator – the number in the denominator who have a reconciled list of their medicines within 1 week of the GP practice receiving the information.
Denominator – the number of people on medicines who are discharged from a care setting.
Data source: Local data collection.
b) Proportion of new prescriptions within 1 month of discharge from a care setting where there was a reconciled list of medicines in the patient's GP record.
Numerator – Number in the denominator where there was a reconciled list of medicines in the patient's GP record.
Denominator – Number of new prescriptions within 1 month of discharge from a care setting.
Data source: Local data collection.
Outcome
a) Harm attributable to errors in medication following discharge from a care setting.
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 following discharge from a care setting.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers (such as GP practices, secondary care and mental health providers) ensure that systems are in place for people discharged from a care setting to have a reconciled list of their medicines in their GP record within 1 week of the GP practice receiving the information, and before a prescription or new supply of medicines is issued. Care providers should ensure comprehensive and accurate information on medicines is supplied to general practices in a timely manner on discharge. GP practices should have systems in place to act on the information received within 1 week.
Health and social care practitioners (such as GPs, secondary care consultants and residential care practitioners) ensure that people discharged from a care setting have a reconciled list of their medicines in their GP record within 1 week of the GP practice receiving the information, and before a prescription or new supply of medicines is issued. Health and social care practitioners should send comprehensive and accurate information on medicines to general practices in a timely manner on discharge. GPs should undertake medicines reconciliation within 1 week, and should not issue new prescriptions or supplies of medicines before medicines reconciliation is complete. General practices may also liaise with community pharmacies about any medicines discharge information the pharmacies receive.
Commissioners commission services that ensure that people discharged from a care setting have a reconciled list of their medicines in their GP record within 1 week of the GP practice receiving the information, and before a prescription or new supply of medicines is issued.
People who take medicines who are discharged from a care setting such as a hospital or residential care have an up‑to‑date list of any medicines they are taking in their GP record within 1 week of the GP practice receiving the information. The person may be involved in making the list if they wish to be. The GP practice should not give new prescriptions or a new supply of medicines until the person's list of medicines has been made and checked.
Source guidance
Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes. NICE guideline NG5 (2015), recommendations 1.3.3 and 1.3.5
Definitions of terms used in this quality statement
Care settings
Care settings from which people are discharged include hospitals, mental health settings and social care residential settings. These care settings should provide lists of medicines to general practices for medicines reconciliation in primary care. [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. [NICE's guideline on medicines optimisation and expert opinion]
Equality and diversity considerations
Primary healthcare professionals should recognise that people's ability to understand the issue of medicines reconciliation may differ, and take this into account if the person wishes to be involved in the medicines reconciliation process. Health and social care practitioners should consider that 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.