Continuity of care during hospital stay: A review and evaluation of medicines reconciliation on admission

Abstract

Background: Errors in the stage of prescribing make approximately 16 % of all medication errors. There is a need to identify the frequency of this, and also to assess the impact of contributions by pharmacists to the patient’s care.

Aim and objectives: To characterise the nature and frequency of medicines errors in patients during the process of admission to hospital, and also to evaluate the new medicines reconciliation service at Ayr Hospital.

Methods: A prospective audit survey was carried out at an acute medical receiving ward at Ayr Hospital. Patients’ records at admission were used to compare the drugs first prescribed by the doctor, with the list made by pharmacist. Patients seen by a pharmacist in the study period were asked to take part in the study. Information about the new MR service was obtained by looking into the MR-forms for each patient, and this was used as a basis for evaluating the service.

Results: In the study period of 5 weeks there were recorded 255 contributions by pharmacist, distributed on 105 patients in total. The median number of discrepancies found per patient was 2.4 and no discrepancies were found in 25/105 (23.8 %) of the cases. Some 67.5 per cent of all the interventions were assessed to be significant and result in an improvement in the standard of care, while 6.7 per cent were assessed to be very significant and prevent a major organ failure or adverse reaction of similar importance.

Conclusion: Pharmacists have an important role in improving the quality of patient care and contributions made by pharmacists are both important and necessary. There is a need for improvement in current practice of how the MR service is delivered.