Pharmacy-led project leads England and Wales in medicines reconciliation

More than 95% of patients in 30 wards at North Bristol NHS Trust now receive medicines reconciliation within 24 hours of admission to hospital, making it the best performing trust in England and Wales according to Quality, Innovation, Productivity and Prevention (QIPP) benchmarking. This achievement is thanks to the efforts of a pharmacy-led team who were finalists in the Pharmaceutical Care Awards, which are jointly organised by the Royal Pharmaceutical Society and The Pharmaceutical Journal and supported by GlaxoSmithKline.

Speaking at the event, held at the Royal Society in London on 18 June 2015, principal pharmacist Jane Smith explained that their work came about as part of the Safer Patients Initiative, a project established by the Institute of Healthcare Improvement in the United States and the Health Foundation in the UK. “Because it came from the Americans, the key words were ‘In God we trust — everyone else, bring data’,” she added.

The project, which seeks to ensure that medicines prescribed on patient admissions correspond to those taken before admissions, began in 2007 and has since been rolled out in five phases. The most recent of these phases, from 2013 to 2014, enabled the team to extend the clinical service to the emergency zone at weekends. The work has also saved the trust £350,000 per year in cost avoidance and £650,000 per year in reusing patients’ unwanted or unused drugs.

Lead pharmacy technician Julie Hamer, who also spoke at the event, highlighted that the major challenge was in trying to establish the audit process. “Originally, we thought we have to audit only on one ward — the admissions ward,” she explained. “We actually found out that only 20% of admissions went through that one ward. So we then established that there were 50 wards where the percentage of admissions was greater than 2%. It was quite a large area that we needed to audit.”

Smith emphasised the importance of implementing such projects slowly in order to ensure changes are sustainable. “The key is embedding it,” she said, “so as you do your spread, you get more people on board with it … you leave your laggards until the end and they’ll come on board because everyone else is doing it.”