Setting

This audit is suited to investigating medication errors at the point of patient transfer between a variety of care settings.

Background

Medication errors are recognised as a common cause of avoidable morbidity and mortality (Dean-Franklin et al, 2005). Approximately 20% of clinical negligence claims on the part of hospitalised patients are due to medication errors (Audit Commission, 2001). The National Patient Safety Agency (NPSA) (2007), in conjunction with the National Institute for Health and Clinical Excellence (NICE), has defined medicines reconciliation as:

ᐅ collecting information on medication history (before admission) using the most recent and accurate sources to create a full and current list of medicines

ᐅ checking or verifying this list against the current hospital prescription chart

ᐅ ensuring any discrepancies are accounted for and actioned appropriately

ᐅ communicating any changes, omissions or discrepancies.

Standards

The NPSA (2007) makes the following recommendations:

ᐅ All healthcare organisations that admit adult in-patients should make sure that they have policies in place for medicines reconciliation on admission.

ᐅ In addition to specifying standardised systems for collecting and documenting information about current medications, policies for medicines reconciliation on admission should ensure that:

Method

Data collection

To assess whether an appropriate policy on medicines reconciliation was present, data were collected to answer the following questions:

ᐅ Does the organisation have an approved or draft policy?

ᐅ Which staff roles have responsibility for medicines reconciliation?

ᐅ Does the policy specify the time frame for reconciliation, which sources of information are required and where to document them?

ᐅ Has an earlier medicines reconciliation audit taken place?

To assess the quality of medicines reconciliation, data should be collected on a questionnaire/audit tool for a minimum of five consecutive in-patient admissions. The audit should be completed after the patient has been admitted for at least 7 days.