Patients' medication when admitted to hospital

Hi everybody

This is Jaione from Spain (we are in the North, Basque Region) and i am a nurse working in collaboration with the Patient Safety Team in our local NHS (Basque Health Service).

First of all, I would like to congratulate the team for this hub which i think is a wonderful idea. Secondly, i would like to apologize for the language, since, although i lived in England many years ago, that is not the case anymore and I'm afraid i don't speak as well as I used to.

I would like to comment a problem that we encounter very often in our organization which is related to patient's regular medications when they are admitted to hospital. We do have online prescriptions for both acute and community settings but the programs don't really speak to each other so, for example, if I take a blood pressure pill everyday and i get admitted into hospital, chances are that my blood pressure tablet won't get prescribed during my in-hospital stay.

The logical thing to do would be to change both online systems so they communicate to each other, but that's not possible at the moment. I wanted to ask whether other systems have the same problem and, if so, if there is any strategy implemented to alleviate this issue.

I hope i have expressed myself as clearly as possible. Thanks very much once more for this hub!

Kind regards

Jaione

 

Hello Jaoine, thank you so much for your post and support. A really good question although I don’t personally know the answer. But let’s hope someone can help you through the hub. I wonder whether Laurie can help you? @Laurence Goldberg FRPharmS

Pharmacists in U.K. hospitals take a medication history when a patient is first admitted to hospital. This will identify all prescribed medicines and medicines that the patient has bought in a pharmacy.The pharmacist then ensures that appropriate medication is made available for these inpatients.

By the way, we call this service 'medicines reconciliation'

I consider this to be a really important topic, so I'm grateful that Jaione brought this up. The work being done in the UK by pharmacists and pharmacy workers is vital to patients and their carers, so the medicines reconciliation programme, designed to optimise compliance and minimise errors has done much to protect patients and maximise their recovery. My continuing worry, however, is implicit in Jaione's original question and it concerns the communication between organisations. There are still many areas across the UK that struggle to coordinate their communication between primary care and other providers, (acute, mental health and other community services), so patients are at risk on the handover when being discharged from one organisation to another. This issue is exacerbated by the fact that many people believe that their records can already be accessed by any health worker in any NHS organisation and so rely on this 'fact' instead of carrying a list of their medications into hospital. 

Thanks everybodu for your input. This hub is great!

I remember when i used to work in the UK that i was amazed at the role of pharmacist since each ward had one allocated. We dont have that here in Spain (at least where i work) and it´s such a shame since medicine reconciliation is vital in our opinion. However, we do have digital notes so they are readily avalibale to any professional within a certain organisation. Because, (very similar to whar Douglas has ponted out, ) we too have different organisations using different digital notes programs that end up not communicating with one another. Effort s are being made to create a single programm accesible from all local organisations so we can keep track of patients across the care spectrum: Whether we will see it before we retire that´s another issue

Summarizing, we seem to be on the same boat to a certain extent; trying to work out safe ways to handle patients´medications. congratulations to everybody on your efforts

Kind regards

@Jaione Hi Jaione, this is a problem in many countries. Healthcare IT systems are often developed to meet the need of different sectors (primary care and secondary / tertiary care) and are developed by different companies to meet different needs. Indeed there is often a problem even within the same organisation (such as a hospital) where a system to support Intensive Care or Theatre or Chemotherapy is developed separately from (and does not communicate with) the system used to support care in the rest of the hospital.

Many hospital systems support the capture of a list of medicines on admission but I agree that this is seldom available as an electronic communication between primary care and secondary care systems, which would be the ideal. The NHS is now working to improve this 'interoperability' between systems, insisting on the use of a standard way of describing the medicine so that the prescription information can pass between systems. The use of Open standards is actually the best way of ensuring that information can be seamlessly transferred between systems but, whilst there is growing interest in this, we are a long way from systems routinely using this process.

A short-term solution might be to work with your system supplier to see if a scan of the barcode on the medicines the patient brings in could then generate a list of medicines on admission ... but this may not provide a comprehensive list and may be prone to error if the medicines brought with the patient included medicines that had been discontinued or even prescribed for someone else in the household and so a well informed individual is needed to support this reconciliation process until we can make progress towards truly interoperable systems. This is both possible and available (I think the Dutch have a 'shared' medication record between primary and secondary care) and would be quicker and cheaper than replacing the systems we have with a 'universal' system (which would probably struggle to meet the needs of all users).

Good luck!