Medicines Reconciliation



to optimize the use of medicines our patients must be at the center of all we do this clip gives an example of how the hospital pharmacies 15 supports the patient first by ensuring medicines are right on the mission and we call that reconciliation then talking to patients about that medicines changes we make we also know how important it is to communicate those changes to the patient's GP and to tell the patient's about the medicines use reviews their community pharmacies may offer a case today is about Alan who's coming into hospital for a hip replacement hi there mr. Smith hi I just say there you're fine thank you my name is Juliana the pharmacist hey do you mind if I have a quick seat okay now it's just once into check when you want any medicines before you came in it is yeah that's obviously for my blood pressure yes that's cholesterol and I also have some fairly strong painkillers but I haven't brought those painkillers as well okay that's fine and each of these do you just take one in the morning absolutely is that right so we've got two blood pressure ones in the morning and you cholesterol one has has anybody ever said the cholesterol one it's actually better to take at night no that's not what I've been advised but are you telling me that it is yes it's more effects if if you take it at night which is why we normally advise it like that it's good are you happy to switch over to that yeah cool I'll get the doctors to write it up that way that's great so here understand you're coming in for your hip replacement yeah so what they'll do is after you've had your operation they're going to start you up on a new medication okay it's a new one basically to once you've had your operation your Bloods at more risk of forming clots which we don't want to happen so they'll give you the very attractive stockings to put on and they'll have you in like probably an inflating and deflating like pumps for the first day or so and then once you get more more more mobile they'll give you the stockings which you'll then have to take home with you afterwards okay and the nurses I'll explain sort of how to get them on and off because they can be quite tight okay and they'll give you a tablet as well and that's called rivaroxaban and you'll start that the day after your operation okay and you'll be on that for 35 days okay yes it means you don't have to have any nasty injections into your tummy or anything like that and all those instructions will be on there they will be on that and I'll run through it again before you're going home anyway okay and the nurses will give them from your drug chart pulsed you're in okay now with with your painkillers said you're on quite a strong one can you well okay we've written you out for one here what we quite like to do is split that into the individual bits so paracetamol and then a stronger painkiller and then it means as you're getting better you can drop down on the stronger painkiller and just take the paracetamol are you happy to see with that okay it's very important not to take these alongside your strong painkillers at home okay but we'll make sure we give you enough when you're going out anyway okay have you any questions for me at all I think that's all explained providing I have the instructions as to when and how often I have to take the bills we will do thank you very much okay can I just double check have you got any allergies to any medicines at all I'm aware of nothing you know laughs okay and do you buy anything extra from the chemist at all any horrible remedies vitamins no okay that's great thank you very much and I'll just pop these tablets in the medicines Locker so the nurses can get hold of them and I'll see you again soon thank you very much thank you hello again mr. Smith hi there are you seeing your chair I'll come back one of the pharmacists I spoke to you earlier about you had the same job yes yes I understand you're now ready to go home absolutely yeah great now I've got a copy of your paperwork here so we'll just have a quick run-through and then I'll give you your copy to take home okay thank you so got your medicines okay all right so I'll give you that back okay so put you two blood pressure tablets which you take one of each in the morning as she did before these are the same as the ones I had absolutely not changed them at all they should one for your cholesterol that we spoke about taking at night remember that we said works bit better that way okay so that's that one otherwise it's exactly the same tablets all right okay so remember now this one is the anticoagulant which we spoke about when you first came in and basically it means your blood will take longer to clot so it means you will have an increased risk of bleeding it's once a day for 35 days so it'll be another 30 days or so because you've had a week since you've been in if you do notice any signs of bleeding stop taking the tablets and make sure you seek medical attention as soon as you can okay and we've got your painkillers here as well so do you remember as well we spoke about changing from your strong painkillers to the individual bits so we could drop one of them exactly so we've got the paracetamol which is two up to four times to do when you need it and you die hydrocodeine which is one or two up to four times a day when you need it so that's the stronger of it okay and if you keep on with past that and all that will give you a good kind of background pain relief and then when you need it you've got the extra bits of die hard recording to go in okay okay and not to take them with anything else a paracetamol in them okay good thing and you've got you have you've got your stockings on for going home yes you look lovely and I'll make sure the nurses have a chat to you before you go about how to get them washed and everything else I think there's a few sort of points around that and what kind of temperature wash and that sort of time you have to go in so sweets nurses okay so that's your copy of the paperwork that's yours to keep and if you do have any questions about your medicines at all and always pop in to community pharmacy they'd be happy to a chat to you if you take that in with you then they'll then know exactly what you've been sent home with okay that's good okay any other questions everything's fine thank you very much indeed for your advice no bother at all okay thank you thank you hello mr. Smith how are you oh very much better now I've had their operation and the hospital have asked me to call in and give you this and I've also got a couple of questions about my drugs all right okay would you like to follow me into the consultation room then yes hey Kate's just over there come on through a bed mr. Smith thank you you're welcome just take a seat please you

1 thought on “Medicines Reconciliation

  • In the hospital that I work in, the pharmacist does not counsel the patient on their medication when they about to be discharged. Its a real shame that there are not enough pharmacists available to do this as, of course, they do a better job of explaining the medicines that the nurses do. We have to face the real work of pharmacy….not the ideal.

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