The Pharmaceutical Journal
Vol 278 No 7452 p575
19 May 2007

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Pilot project will result in guidance on medicines reconciliation

Guidance on a standard approach to medicines reconciliation on admission to hospital in order to address patient safety problems is to be produced by the National Institute for Health and Clinical Excellence, in collaboration with the National Patient Safety Agency.

The two organisations are working on a pilot project, which will assess the clinical and cost-effectiveness of systems-based and IT-based interventions in medicines reconciliation. It will result in a technical patient safety solution for the NHS, which will carry the weight of NICE guidance.

If the pilot is successful, NICE hopes that it will go on to develop further guidance on cost-effective interventions to prevent or mitigate patient harm, in conjunction with the NPSA.

Medicines reconciliation is defined by the Institute of Healthcare Improvement as “the process of identifying the most accurate list of a patient’s current medicines — including name, dosage, frequency and route — and comparing it to the current list in use, recognising any discrepancies and documenting any changes, thus resulting in a complete list of medicines, accurately communicated”.

Medicines reconciliation is a long-standing and well-recognised problem that can lead to patient harm. NPSA data show that the number of reported incidents of medication errors involving admission and discharge between November 2003 and March 2007 was 7,070, with two fatalities and 30 that caused severe harm to the patient.

David Cousins, head of safe medication practice at the NPSA, told The Journal that there are a number of techniques for medicines reconciliation currently in operation and NICE will be looking at published, unpublished and ongoing studies, such as the work of the Safer Patients Initiative (PJ, 25 November 2006, p630) on medicines reconciliation.

Andrew Dillon, chief executive of NICE, said: “The core principles we apply to all guidance development — the use of independent expert committees, genuine public consultation and an open decision-making process — will be applied to this project.”

The pilot project will also assess interventions to prevent ventilator-associated pneumonia. The draft scopes (which define what the safety solution will cover and to whom it will apply) for both of these topics are currently out for consultation and are available online. Guidance is expected to be issued to the NHS in November 2007.