Quality in secondary care, from admission to prescription!

Session 6, “Striving to achieve quality in secondary care”, raised questions about medicines history taking. Jan Basey from the Royal Liverpool University Hospital NHS Trust presented research on medicines reconciliation, from admission to prescription. Using direct observation, the study explored the processes used by prescribers conducting medicines reconciliation in hospitals. Ms Basey gave qualitative insight into the questions she had overheard being asked (or not being asked) by the staff taking medication histories on the wards (who were all doctors apart from one nurse). The results were surprising at times. Patients were asked medication-related questions in only 76 per cent of the 51 cases observed. In 49 per cent of these, staff made no attempt to confirm the patient’s medication history with them before documenting or prescribing. Perhaps most surprising to those present, was the fact that only 3 of the 51 patients involved in the study were asked about their use of over the counter medication. 

Researchers observed the correlation between poor medicines reconciliation and prescribing errors, and reviewed the information sources used by staff to obtain information about the patients’ medication histories. Findings showed that many sources of information were “left untapped”, and that staff were likely to over-rely on a single source rather than exploring wider options.

Ms Basey’s presentation indicated the need to review staff training and the retraining of doctors to avoid prescribing errors, which result from lack of communication with respect to medicines history taking, and led delegates to wonder if there is a larger role for pharmacists to play in conducting medicines reconciliation in hospital. The conclusion the researchers came to was that increasing the quality of medicines reconciliation processes by improved education could lead to not only better communication with patients, but potentially a reduced risk of medication errors.

By Connie Pringle