Process measures
| Measure | Measure in sample of 10 patients per week randomly selected from all discharges for the week | Detail |
|---|---|---|
| 1 | Percentage of patients with pharmacist-verified reconciliation on admission | Pharmacist has documented on ePR that they have checked the admission medication list with the patient and verified with a second source and clarified or resolved any discrepancies on the inpatient order with the prescriber |
| 2 | Percentage of patients with pharmacist-verified reconciliation at discharge out of the total number of patients sampled | Reconciliation at discharge is possible only for patients with a verified admissions medication list. For this measure, any change to any admission medicine, dose, frequency or route is confirmed by a pharmacist as intentional and documented clearly on the discharge summary as such |
| 3 | Percentage of patients with error-free TTO prescriptions | TTO has no unexplained discrepancy compared with the verified list of medicines on admission. The reason is stated for any omission, change in dose, frequency or route; course lengths and monitoring advice are given where needed. If no reason is given for a discrepancy then the patient does not have an error-free prescription |
| 4 | Percentage of medications unreconciled at discharge out of the total number of medicines within the sample of 10 discharge summaries per week | Measure 4 is directly related to measure 3. The number of individual medicines unreconciled were recorded. Patients on no medicines were included in the study; medicines reconciliation was considered reliable only if ‘nil regular medication’ was verified and documented as such |
| 5 | Percentage of medications with an error (or omission) on TTO out of the total number of medicines within the sample of 10 discharge summaries per week | Measure 5 is directly related to measure 3. The number of individual medicines with an error or omitted without explanation were recorded. For each patient, several medicines may be prescribed in error or omitted from the TTO |
ePR, electronic prescribing system; TTO, take-home medicines