Medical reconciliation to reduce medication errors

Background

Client: A group of GP practices in the South Coast
Service Provider: National Clinical Services (NCS)
Project Duration: Ongoing
Objective: Provide medication reconciliation support to improve patient safety and medication accuracy across multiple practices

A group of GP practices along the South Coast faced challenges in keeping up with medication reconciliation for patients following hospital discharges, care transfers, and other transitions. Medication reconciliation is critical in ensuring that patients receive the correct medications and that any discrepancies are identified and resolved promptly. National Clinical Services (NCS) was tasked with remotely providing medication reconciliation services to improve efficiency and patient safety across these practices.

Approach

NCS deployed a team of pharmacists working remotely to provide comprehensive medication reconciliation services. The aim was to ensure that all patient medications were correctly documented and reviewed, minimising the risk of errors, adverse drug reactions, or duplication of treatments. The services provided included:

• Hospital Discharge Summaries: Pharmacists reviewed medication changes made during hospital admissions, ensuring they were accurately reflected in the GP records and implemented into patients’ medication plans.
• Care Home Transitions: When patients transferred between care homes and their GP practices, NCS pharmacists ensured seamless medication continuity by reviewing and updating medication records.
• Polypharmacy Reviews: NCS conducted in-depth reviews for patients on multiple medications to identify any potential drug interactions or unnecessary prescribing, making recommendations to streamline and optimise medication use.
• New Prescriptions Monitoring: Pharmacists carefully reviewed new prescriptions, particularly for high-risk drugs like anticoagulants or immunosuppressants, ensuring they were prescribed and monitored appropriately.
• Chronic Disease Medication Adjustments: Pharmacists reconciled medications for patients with chronic diseases such as diabetes, hypertension, and COPD, ensuring that changes in treatment regimens were correctly applied.
• Patient Communication: NCS pharmacists liaised with patients where necessary to clarify any changes made to their medications, helping to improve understanding and adherence.

Results

• Improved Patient Safety: By ensuring accurate reconciliation of medications after transitions of care, NCS helped reduce the risk of medication errors, adverse reactions, and missed doses.
• Timely Updates: GP records were updated promptly following hospital discharges and other transitions, allowing GPs to make informed decisions about patient care.
• Streamlined Prescribing: The polypharmacy reviews led to a reduction in unnecessary medications and an optimised approach to chronic disease management.
• Efficient Remote Working: The remote working model proved successful, allowing NCS to provide these services across multiple practices without the need for on-site presence, saving time and resources.

Conclusion

National Clinical Services played a vital role in supporting a group of South Coast GP practices by delivering medication reconciliation services remotely. By ensuring medication accuracy following hospital discharges and other transitions, NCS significantly improved patient safety and helped streamline prescribing practices. The practices benefited from timely updates and enhanced patient communication, demonstrating the value of remote pharmacist-led medication reconciliation.