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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