How nurses contribute to medicines reconciliation.

MEDICINES RECONCILIATION (MedRec) is recognised globally as a vital aspect of patient safety. The World Health Organization (WHO) has identified MedRec as a priority for action as part of its High 5s project, launched in 2006, to address continuing patient-safety concerns. Similarly, and in line with the High 5s project, national organisations such as the National Institute for Health and Care Excellence (NICE) and the National Patient Safety Agency (NPSA) (2007), the Canadian Patient Safety Institute (2015), the Institute for Safe Medication Practices Canada (2015) and the Joint Commission (2015), in the US, have all issued guidance and directives to drive and improve the MedRec process. In August 2014, NHS England issued a patient safety alert about the risks arising from the breakdown of, and failure to act on, communication during handover when patients are discharged from secondary to primary and social care (NHS England 2014). An accurate and well documented MedRec at admission and during a hospital stay is critical to ensuring accurate communication about medicines at discharge. Despite the high status of MedRec as a patient safety issue, and the significant work done to drive and implement robust MedRec processes, a consensus statement from stakeholders has called for further efforts to identify and disseminate best practice (Greenwald et al 2010). A collaborative audit by the East and South East England Specialist Pharmacy Services in 2010, which involved 56 NHS organisations and covered 33,120 beds, found that 52% of acute hospital patients received MedRec by a member of the pharmacy team within 24 hours. More than 8,600 MedRecs, covering about 49,100 admission drugs with an average of 5.6 drugs per patient, were audited. In this sample, 11,366 unintentional discrepancies were identified, equating to an average of 1.32 drug discrepancies per MedRec (Dodds 2010). International studies indicate similar issues and trends. For example, in two literature reviews, variances between the medications that patients were prescribed at admission and what they took ranged between 30% and 70% (Gleason et al 2004, Cornish et al 2005). Another study of MedRec errors and risk factors at hospital admission noted that 36% of patients had errors in their admission medication prescriptions, with most occurring as medication history was gathered (Gleason et al 2010). As healthcare delivery systems become more complex and involve more care providers, the risk of medical errors particularly at transitions of care increases (Rozich and Resar 2001). According to the Abstract