Improving and maintaining medicines reconciliation on admission

NICE Quality and Productivity Case Studies
North Bristol NHS Trust
Publication date:
30 November 2016


North Bristol NHS Trust is a trust in South West England. It has approximately 1,000 beds, and treats about 70,000 patients annually via elective and emergency admissions. This project was designed to ensure medicines reconciliation was carried out within 24 hours of admission, to help optimise prescribing and reduce medication errors.

This work uses the SPI improvement methodology starting with the use of the model for improvement and ‘Plan, Do, Study, Act’ (PDSA) cycles as well as tests of change on 1 ward. The methodology requires a sample of 5 patients per ward per week to be used. As such, it could only be undertaken on wards with a significant number of admissions each week.

The team focussed on the wards with the greatest number of admissions (>2% of total admissions). It also set in place definitions for :

Reconciliation within 24 hours of admission. In line with the NHS definition, medicines reconciliation had to be completed no later than 5pm on the second day after admission.

Completion of medicines reconciliation: the point at which all changes to prescribed medicines had been highlighted but not necessarily acted on. Any urgent changes, which if left unchanged could result in patient harm, would be acted on immediately.