Quality statement 1: Medicines reconciliation | Physical health of people in prisons | Quality standards

Quality statement

People entering or transferring between prisons have a medicines reconciliation carried out before their second-stage health assessment.

Rationale

Medicines reconciliation helps ensure that people continue to receive the medicines they need and reduces the risk of harm caused by delayed or inappropriate medication. This is done within 7 days of arrival in a prison to ensure parity with primary care in the community, as outlined in the NICE guideline on medicines optimisation. This is particularly important for people who receive regular medication for long-term conditions.

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 an accurate list of a person's current medicines is obtained from the person's GP, other healthcare professionals and, where appropriate, the transferring prison healthcare team.

Data source: Local data collection including local data sharing agreements and prison transfer protocols.

b) Evidence of local arrangements to ensure that a list of the medicines currently being taken by a person is obtained from them.

Data source: Local data collection including first-stage health assessment documentation.

c) Evidence of local arrangements to ensure that medicines reconciliation is carried out before the second-stage health assessment.

Data source: Local data collection including medicines pathways.

Process

Proportion of second-stage health assessments for people entering or transferring between prisons where medicines reconciliation has already been carried out.

Numerator – the number in the denominator where a medicines reconciliation was carried out before the second-stage health assessment.

Denominator – the number of second-stage health assessments for people entering or transferring between prisons.

Data source: The NHS England health and justice indicators of performance include data on medicines reconciliation being completed within 72 hours of entering prison.

Outcome

a) Number of adverse medication events in prison.

Data source: Local data collection including healthcare records (SystmOne).

b) Number of hospital admissions of people in prison because of adverse medication events.

Data source: Local data collection including healthcare records. The NHS England health and justice indicators of performance include data on escorts and bedwatches for urgent care.

What the quality statement means for different audiences

Service providers (providers of healthcare in prisons) ensure that systems are in place for a medicines reconciliation to be carried out before the second-stage health assessment so that the outcome of the medicines reconciliation can be acted on at the assessment. This includes having arrangements in place with GPs, other healthcare providers and prisons to share medicines information to ensure they can collate an accurate list of the medicines a person should be receiving.

Healthcare professionals (GPs, pharmacists, pharmacy technicians and nurses in prisons) carry out a medicines reconciliation before the second-stage health assessment and act on the outcome to ensure that the person is receiving the correct medicines. This can include checking that the person is taking the medicines, and ensuring that they have not had an adverse reaction to medicines they are taking and have no relevant known allergies.

Commissioners (NHS England) ensure that their contracts and monitoring arrangements include the requirement for prison healthcare services to carry out a medicines reconciliation before the second-stage health assessment. They should also include the requirement for integrated working between prisons, GPs and other healthcare providers.

People in prison have an accurate list of their medicines prepared for them before they have their second health assessment in prison. This means their healthcare professional can make sure they get the medicines they need while they are in prison.

Source guidance

Physical health of people in prison. NICE guideline NG57 (2016), recommendation 1.1.8

Definitions of terms used in this quality statement

Medicines reconciliation

The process of identifying an accurate list of a person's current medicines and comparing them with the current list in use, recognising any discrepancies, and documenting any changes, thereby resulting in a complete list of medicines, accurately communicated. [NICE's guideline on physical health of people in prison]

Second-stage health assessment

A health assessment carried out within 7 days of a person's first-stage assessment which takes place upon entry into prison. This assessment includes, as a minimum;

reviewing the actions and outcomes from the first-stage health assessment
asking the person about:
- any previous misuse of alcohol, use of drugs or improper use of prescription medicine
- if they have ever had a head injury or lost consciousness, and if so:
  - how many times this has happened
  - whether they have ever been unconscious for more than 20 minutes
  - whether they have any problems with their memory or concentration
- smoking history
- the date of their last sexual health screen
- any history of serious illness in their family (for example, heart disease, diabetes, epilepsy, cancer or chronic conditions)
- their expected release date (if less than 1 month a pre-release health assessment should be planned)
- whether they have ever had a screening test (for example, a cervical screening test or mammogram)
- whether they have, or have had, any gynaecological problems
measuring and recording the person's height, weight, pulse, blood pressure and temperature, and carrying out a urinalysis.

[Adapted from NICE's guideline on physical health of people in prison, recommendation 1.1.13]