Download document - Herts Valleys CCG

Local Incentive Scheme 2016-17
Supporting Tools for Medicines Reconciliation in Primary Care
Medicines reconciliation is defined by the Institute for Healthcare Improvement (IHI) as:
“the process of obtaining an up-to-date and accurate medication list that has been compared to
the most recently available information and has documented any discrepancies, changes,
deletions and/or additions resulting in a complete list of medications, accurately
communicated.”
Content
1. Read Codes to be used in the Medicines Reconciliation Process
2. Medicines Reconciliation Template
3. Medicines Reconciliation Audit Data Collection Form
1. Read Codes Used in the Medicines Reconciliation Process
These READ codes are included in the template but they may also be added manually into the consultation
or journal
Template field
Letter received
Medicines reconciliation
Drug therapy discontinued
New medication commenced
Medication changed (strength, dose or form)
Place of Discharge
o Discharged from inpatient care
o Discharged from outpatients
o Discharge from accident and emergency
o Discharged from day-case care
Post hospital discharge medication reconciliation with patient
Supporting Tool for Medicines Reconciliation in Primary Care
March 2016
EMIS/Vision
9N3D
8B318
8B3R.
8B3A3
8B316
System One
XaKqd
XaXfG
XM18N
XE0hn
8B316
8HE2.
8HE1.
8HE8.
8HE3.
8B3S0
8HE2.
8HE1.
XaKYE
8HE3.
XaWSQ
Page 1
2. Medicines Reconciliation Template
A template has been developed for EMIS web, System one, and Vision to help GPs with the recording of
medicines reconciliation. The template will incorporate all the above codes.
Use of the medicines reconciliation template is not compulsory but is a very useful tool to record various
actions that may take place when clinicians carry out medicines reconciliation. As some of the fields are
also included within the medicines reconciliation audit tool (LIS requirement), by completing the template
the process of completing the audit tool will become easier.
Alternatively in the patient’s medical record please use the READ code “8B318 (EMIS/Vision) OR XaXfG
(System One) – Medicines reconciliation” and free type actions taken.
Screenshot without dropdown menu
Screenshot showing dropdown menu
Supporting Tool for Medicines Reconciliation in Primary Care
March 2016
Page 2
How to Use the Medicines Reconciliation Template
Instructions of how to import the template into your clinical system, access it during a consultation and
save it, can be provided by Nicola Baker, GP IT Facilitator, HVCCG. Nicola can be contacted with any
questions at [email protected]. The template will be available on the HVCCG intranet.
On opening the template a box pops up with a number of tick boxes with an area to add notes. The tick
boxes are described below.
Letter received
Medicines Reconciliation
and date
No change to Drug
Treatment
Add the date that the letter was received by the practice.
Ticking this box records medicines reconciliation in the medical record and
read-codes this activity. (Note in System One you do not need to tick the
box but you MUST annotate some text in the box to record the read-code –
this can be as short as “done”)
A text box is available to add any notes
Tick if NO changes were made to the patient’s current medication.
No read code is attached to this field hence it is for information only.
For VISION practices, this can only be annotated in the free text section
attached to the Medicines Reconciliation section.
You may wish to add medication changed, stopped or started and record patient discussions in the
following tick box sections. Each will have a notes box.
Drug therapy discontinued
Record any medicines stopped.
Please write medication details and a reason if possible. If medication is
stopped due to allergy or adverse drug reaction you may wish to enter this
in the journal in the usual way to ensure allergy read-code is picked up.
New medication
Add details of new medication and a brief note if relevant e.g. clopidogrel
commenced
for x months.
Medication changed
Add details of any changes made in dose/formulation/strength and a reason
if appropriate.
Place of discharge and date Use the drop down list to select whether discharge was from inpatient care,
outpatients, accident and emergency or day-case care. Date box to record
date of discharge.
Post hospital discharge
Record any discussions or follow up with the patient. Date box to
medication reconciliation
record when discussions were had with the patient.
with patient
Enter ‘n/a’ (with reasons) in the text box if further discussions with the
patient is not necessary.
Supporting Tool for Medicines Reconciliation in Primary Care
March 2016
Page 3
3. Medicines Reconciliation Audit Data Collection Form
This audit has been produced to review the quality of the medicines reconciliation process and practices
are required to use the results of the audit to make recommendations to further improve this process for
the practice.
Submission of the audit and recommendations for improvement are required to qualify for payment.
The audit data collection sheet is available for practices to use as an excel spreadsheet and is attached. A
screen shot is shown in Appendix 1.
Practices should complete and submit this form electronically.
The following information is to be collated within the audit:
Patient
Patient ID
Age
No. of repeat medication in
medical record
Time, in days, elapsed from
discharge letter date to
receiving at the practice
Did medicines reconciliation
occur within 7 days of the
practice receiving the
information?
Was the medicines
reconciliation performed by a
GP or a non-medical
prescriber with an
appropriate prescribing
qualification?
Has the read code for
medicines reconciliation
(EMIS/Vision - 8B318 and
System One - XaXfG) been
used?
Is it documented that any
changes to the medications
Labelled 1-40 to allow practice to review the number of patients which
need to be reviewed to meet the criteria outlined in the LIS 16-17.
(2 patient to be audited for every 1000 registered patients in the practice)
Should be identifiable by the practice (for verification purposes) but
should NOT include patient identifiable data.
To ensure that patients are audited in line with the LIS requirements of
≥75 years old. This age bracket can be reduced if enough patients cannot
be found for audit purposes.
To ensure that patients are audited in line with the LIS requirement of
≥repeat medications
This will identify delays from discharge to receiving the letter. Discharge
information should be clear, unambiguous and legible and should be
available to the GP (or other primary care prescriber) as soon as possible.
This is recommended good practice. This will also help identify delays in
medicine reconciliation. This process is also central to reducing the risk of
medication error; if not carried out, in more extreme cases this could
result in patients taking duplicate medicines or taking medicines that are
incompatible which increases the risk of complications. Also hospitals
usually discharge patients with 2 weeks supply of medicines; it is essential
reconciliation takes place as soon as possible to prevent delays in
medication and distress to patients.
Medicines reconciliation requires clinical judgement and should only be
undertaken by competent clinicians, preferably a GP or non-medical
prescriber (e.g. nurse prescriber, independent pharmacist prescriber).
Non-clinical staff should only undertake the administrative aspects of
reconciliation.
This can be done via the template or manually within the patient’s medical
record.
Some practices use this read code for outpatient’s reconciliation and use
Post Hospital discharge medication reconciliation with medical records
(8B3S1). This is acceptable as long as it is clear in the practice’s policy.
An option to enter not applicable is available as it is not always necessary
to contact the patient.
Supporting Tool for Medicines Reconciliation in Primary Care
March 2016
Page 4
have been discussed with the
patient or their
representative?
Has the medication
information outlined in the
discharge letter been
transferred to the patient's
medical record correctly?
Recommendation for practice
improvement/Action Plan
A read code (EMIS/Vision - 8B3S0 OR System One - XaWSQ) should be
added if any discussions with the patient were undertaken.`
Any medication transcription errors, with regards to medication,
formulations, strength and/or dose to be identified and noted at the
bottom of the audit form.
Practice to review the results of the audit, review them against the
relevant section of their repeat prescribing policy and produce an action
plan detailing how current practice could be improved to improve patient
safety and to reduce risks.
Acknowledgements
Surrey Downs CCG
Supporting Tool for Medicines Reconciliation in Primary Care
March 2016
Page 5
Appendix 1:
This audit tool is available in an Excel format and will be circulated to practices with the Supporting Information Packs.
Supporting Tool for Medicines Reconciliation in Primary Care
March 2016
Page 6