ISQUA17-3144MEDICINES RECONCILIATION IN PRIMARY CARE FOLLOWING HOSPITALISATION

Abstract

Objectives: Medication reconciliation is an effective way of reducing errors at transitions of care. Much of the focus in the UK has been on medicines reconciliation on admission to hospital, until national guidance,[1] a NHS England patient safety alert[2] and changes to the NHS England Standard Contract broadened this to primary care. The objective was to assess the completeness, timeliness and reconciliation in primary care of medicines information on hospital discharge summaries. Methods: Clinical Commissioning Groups (CCGs) across England were invited to participate in a collaborative project during January 2016 for patients discharged during the previous three months. CCG pharmacists identified patients retrospectively from GP prescribing systems and collected data using a standardised tool based on national standards, developed by a multidisciplinary group and validated through a series of pilots. Anonymised data were entered onto an excel spreadsheet by the CCG pharmacists and submitted electronically for collation and analysis. Results: 47 CCGs participated and submitted data for 1454 patients (3-404 per CCG). Key findings are summarised in the table. Although many discharge summaries were generated (89%) and transferred (72%) electronically, only 43% were received by the GP practice on the same day. Overall patient demographics were stated on most of the discharge summaries, except allergy status which was only documented in 75.8% of cases. Majority of the medication details were stated except formulation (60.3%) and instructions for ongoing use or supply (72.5%). Reason for initiation of new medicines was documented in half of the 79% where at least one new medicine was started. Apparent unintentional omissions of pre-admission medicines were noted for a third of the patients. Intentional changes were actioned on the GP system within 7 days of the discharge for 42.5% of patients primarily by the GP (51.5%), CCG or practice pharmacist (6.6%), or receptionist (5.6%). At least one change was actioned incorrectly for 5.5% of patients. Median length of stay 4 days (range 0-208) Route of admission 78.6% unplanned At least one new medicine started in hospital 79% of patients; 3,164 new medicines Medicines intentionally stopped in hospital 27% of patients; 738 medicines Unintentional omission of pre admission medicines 33% of patients; 1,565 medicines Dose changes following hospitalisation 23% of patients Total number of medicines prescribed 10,039 Discharge summaries 1,454 Format 89% electronic; 11% handwritten Transfer method to General Practitioner 72% electronic; 12% posted; 16% unable to identify Number of days to receipt 43% on the same day (range 0 - 38 days) Proportion of patients with medication changes actioned within 7 days 42.5% yes; 12.5% no; 42% no action required or an active decision not to action the change. Conclusion: Medicines reconciliation in primary care is as important as on admission to hospital. Our evaluation revealed errors and discrepancies across both care settings, and that despite increasing use of electronic discharge summaries only 43% were received on the same day. There is scope to maximise transfer and action on information to improve safety.