The results

demonstrate that there is still work to be do

The results

demonstrate that there is still work to be done to improve the quality of written medicines information at discharge from hospital. Proactive education and training of prescribers on the importance of information accuracy, and the need to include information in care notes as well as in discharge prescriptions on changes to medication and need for GP follow up may be a better use of pharmacist selleck products resource than reactive and repetitive correction of mistakes. 1. Royal Pharmaceutical Society. Keeping patients safe when they transfer between care providers- getting the medicines right. Final report. June 2012. Available from Linda Dodds Medicines Use and Safety Division, East and SE England Specialist Pharmacy Services, Kent, UK Pharmacy-led medicines reconciliation (pMR) at admission to hospital has been Bortezomib demonstrated to improve the accuracy and appropriateness of prescribing during the hospital stay When pMR had been carried out pharmacists reported that it helped ensure discharge prescription accuracy in 71% of instances and helped identify a problem that

may otherwise have been missed in the remaining 29% pMR supports the accuracy and completeness of discharge prescriptions and may also help reduce the time required to screen discharge prescriptions. It is well recognised that errors in transfer of medicines information across care settings can result in adverse events which can impact on patient morbidity and mortality, cause readmissions to hospital and increased use of primary care resource.1 Pharmacy-led medicines reconciliation at admission can help ensure that inpatient prescriptions are accurate and appropriate.1,2 In a collaborative audit in 2010 across East and South East England it was demonstrated that an average of 1.32 unintentional prescribing discrepancies per patient were identified by pharmacy teams at admission.2 The Medicines Use and Safety Division (MUSD) of East and SE England Specialist Pharmacy Services facilitate

a network of clinical pharmacists. A collaborative BCKDHA audit and service evaluation was proposed to review the accuracy and appropriateness of discharge prescription information relating to medicines. As part of the service evaluation participants were asked to document what contributions had been made to ensuring the accuracy and completeness of the final prescription. They were also asked to record whether a pharmacy-led medicines reconciliation had been carried out for the patient and to make a judgment on its impact on the clinical screening of the discharge prescription. A small steering group of clinical pharmacy managers met with the MUSD to agree methodology and then pilot the protocol. Trusts across the geography were invited to collect data in November 2012.

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