Title: Medicines reconciliation at the interface: A pilot randomised controlled trial to determine the costs and effects of a pharmacy provided service
Funder: Department of Health (England)

Abstract: Background Medicines reconciliation (MR) is the process of ensuring that patients receive the correct medicines when transferring between care settings. Medication errors on admission to hospital have been demonstrated to increase patient morbidity, patient mortality and length of stay. Based on a single randomised controlled trial with errors as the primary outcome measure, NICE/NPSA guidance now recommends that pharmacists should be involved in MR for all hospital admissions. This target is currently being met for 50% of admissions across the Eastern region. The cost and effects associated with expanding this pharmacy service to all admissions are currently unknown. This project is designed to determine the best approach to performing a full scale trial on an expanded pharmacist led MR service. Aims To determine the design of a randomised controlled trial of an extended pharmacy medicines reconciliation (MR) service in different medical clinical specialities. To estimate the effect of such a service on length of stay (LOS) (primary outcome measure), medication errors, patients’ health-related quality of life, health resource utilisation, post discharge medication errors and re-hospitalisation rate (secondary outcome measures) To determine recruitment and retention rates To describe an appropriate approach to recruitment To determine which patients potentially receive most benefit from the intervention To develop an evidence based standard operating procedure for providing an MR service Plan of Investigation Phase 1 Trial development (6 months) • Literature search • Health care professional and patient focus groups to agree service and study design • Pilot wards identified via focus groups • Ethical approval sought & obtained Phase 2 Pilot (9 months) • 200 patients recruited and randomised to intervention or control • Medicines information collected for all patients • Intervention patients receive medicines reconciliation service from pharmacist 3 months post discharge Comparison between intervention and control of: • Health-related quality of life & health services resource use • Length of stay • Medication errors Phase 3 Dissemination (6 months) • Health care professional and patient focus groups • Paper preparation & dissemination Potential Impact The 50% of patients who currently do not receive MR from a pharmacist on admission are at an increased risk of medication error. The results of this pilot will provide some insight into the value of and need for expanding MR to all hospital admissions. It is necessary to determine the costs and effects of such a service to inform decision making regarding resource allocation. This study will describe how such a service should best be delivered, determine recruitment and retention rates and estimate effect size to enable a larger study to be appropriately powered and designed. The development of an evidence based standard operating procedure will also be useful for dissemination to other hospitals.


Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE