A case for pharmacist assisted medicine reconciliation in general practice
Every day in our health system patients transition between primary and secondary care services. For the patient this transition comes with risks, one of which is medication errors. Published literature indicates that more than 50 percent of medication errors occur during transitions of care (Health Quality Safety Commission, 2018).
A thorough medicine reconciliation process in primary care can identify medicine changes and errors and reduce the potential for harm associated with this transition. A robust medicine reconciliation involves comparing medicines documentation generated in secondary care, with the medication and adverse drug reactions lists held in the general practice patient management system (PMS) and documenting any discrepancies.
Medicines reconciliation is something all pharmacists can play a role in. In secondary care evidence indicates involving a pharmacist in medicines reconciliation is associated with an increase in the accuracy of medicines documentation (Tong, Roman, Mitra, Yip, Gibbs, Newnham, Smit, Galbraith, & Dooley, 2017) and we would expect to see a similar effect in general practice.
For some time the importance of medication reconciliation at the transfer of care has been recognised by the Health Quality and Safety Commission and by the Royal New Zealand College of General Practitioners as part of the Cornerstone accreditation (2014).
Recently the Royal New Zealand College of General Practitioners (2019) signalled medicines reconciliation is something all general practices should be doing by including it as a requirement in the recently released draft Foundation standards.
Medicines reconciliation is something all pharmacists can play a role in. In secondary care evidence indicates involving a pharmacist in medicines reconciliation is associated with an increase in the accuracy of medicines documentation (Tong, Roman, Mitra, Yip, Gibbs, Newnham, Smit, Galbraith, & Dooley, 2017) and we would expect to see a similar effect in general practice.
In Canterbury some general practices have already recognised the value pharmacists can add to their medication reconciliation process, both from a patient safety and a practice efficiency point of view, and as such have contracted community pharmacists to be part of their processes.
Expected benefits
For the practice:
General practitioners and nurse practitioners (prescribers) spend less time reviewing discharge summaries and specialist letters
Prescribers spend less time keeping medication lists up to date
Nurses, healthcare assistants and locum prescribers find it easier to get a clear picture of the patients’ long term medications because changes are documented in standardised way
Receptionists, nurses and prescribers all spend less time resolving repeat prescription issues identified by community pharmacists
For patients:
Medication changes that have previously failed are promptly flagged for prescriber action
Unintended medication changes or errors in discharge prescriptions following a transfer of care are promptly identified and resolved
Patients spend less time waiting for medicines to be dispensed because fewer prescriptions require clarification, from the GP team, before they can be released
Process Overview
Practice resource required
A relatively small investment, of two hours of pharmacist time per week, would be sufficient to have an impact in most practices however the exact amount of pharmacist time required will vary depending on the size of the practice and case mix of the enrolled population.
Which pharmacists can provide this service
All pharmacists have the ability to provide medicines reconciliation and your local community pharmacy can assist you with this. Using a community pharmacy in the same neighbourhood may mean they can spread the two hours out over multiple visits throughout the week.
We encourage you to explore this opportunity with your local community pharmacy.
Next steps
Click here to download A document that can be used to explain pharmacist assisted medicine reconciliation to your local General Practice.
Click here to download A document with some key process steps that need to be discussed with practices interested and pharmacist assisted medicine reconciliation.
Click here for general information on medicine reconciliation from the Health Quality Safety Commission.