Medicines reconciliation admission pathways

What is the difference between an inpatient and an outpatient?

Inpatients stay overnight; outpatients attend for assessment or treatment without staying overnight.

What is a "day patient" also known as?

A day case (e.g. for day surgery or dialysis).

What are the two main types of hospital admissions?

Planned (elective) and unplanned (emergency) admissions.

What proportion of admissions are emergency?

Approximately 35%.

Give two examples of admitting units.

AMU (acute medical unit), SAU (surgical admissions unit).

Name three medical risk factors for emergency readmission.

COPD, diabetes, heart failure.

Name two psychosocial risk factors for readmission.

Living alone, functional disability.

What patient characteristics increase readmission risk?

Male, over 80 years old, >3 chronic diseases.

List three common medicines-related problems at hospital admission.

Medication errors, discrepancies, omitted doses.

Name one reason critical medicines are delayed or omitted in hospital.

Medicine not stocked or unfamiliar preparation.

What are examples of time-critical medications?

Parkinson's meds, insulin, injectable antibiotics.

Define medicines reconciliation.

A process to ensure an accurate and complete list of a patient's current medicines is documented and actioned.

What are the 3 Cs of medicines reconciliation?

Collecting, Checking, Communicating.

Name two sources for drug history.

SCR (Summary Care Record), GP printout.

What does NICE guideline NG5 recommend about MR in acute care?

Should occur within 24 hours of admission or sooner if needed.

What does PSG1 recommend regarding MR in hospitals?

MR should be completed within 24 hours of adult admission, and pharmacists should be involved early.

According to NG5, what is the responsibility of organisations in MR?

Ensure designated, trained professionals are responsible for MR.

What information should be transferred with the patient at discharge?

Complete list of current and changed medicines in a suitable format.

What support should be considered for discharge?

Pharmacist counselling, follow-up calls, GP home visits.

How soon should GPs reconcile medicines after discharge?

As soon as practical, ideally within 1 week.

What tasks does a pre-admission clinic pharmacist perform?

Drug history, checking PODs, prescribing, counselling.

What is the role of the AAU pharmacist?

Medication reconciliation, clinical input, discharge supply.

How does a frail elderly pharmacist reduce admissions?

Polypharmacy management and deprescribing.

What are ED pharmacist duties?

High-risk patient MR, medicines advice, discharge support.

According to RPS Standard 2, what must happen at admission?

Medicines must be reviewed for an accurate history.

What is the focus of NICE NG5 regarding medicine optimisation?

Best use of medicines through review, reconciliation, and shared decisions.