The respective proportions at re-audit were very similar (6%, 65%, 10%, 10% and 10%). In those patients who were known to have been prescribed medication prior to admission, the proportions in which the drug name and dose were clearly documented were similar across adult, elderly and forensic services, being 73%, 77% and 89% at baseline, and 77%, 77% and 77% at re-audit. Documentation of an assessment of medication adherence is shown in Figure

2. Figure 2. Documentation Inhibitors,research,lifescience,medical of adherence to prescribed medication in acute adult, acute elderly and forensic services, for those in whom medication was prescribed, at baseline and re-audit. There was no documented statement about adherence Inhibitors,research,lifescience,medical to medication in 41% adults, … Documentation of the reconciliation process overall was generally good and accurately reflected the practice described above in over 80% of cases. Examples of the reconciliation Galunisertib in vitro discrepancies described by clinical teams Inhibitors,research,lifescience,medical are shown in Table 4. Note that these data are presented in a pragmatic way that is likely to be meaningful to practising clinicians. They were not subject to quantitative or qualitative

analyses and no theoretical model was applied. Table 4. Examples of discrepancies identified during medicines reconciliation, and their potential to be clinically significant. Discussion In this QIP, our proxy measure of medicines reconciliation practice was the proportion of newly admitted patients for whom two or more sources of information about the medicines they were taking immediately prior Inhibitors,research,lifescience,medical to hospital admission had been checked. We found that this proportion, representing all those patients for whom medicines reconciliation was possible, Inhibitors,research,lifescience,medical increased modestly between baseline (71%) and re-audit (79%). Most of

the activity related to checking sources occurred in the first 24 h of admission to hospital, irrespective of the time of admission, and most of this activity was documented in patients’ clinical records. The sources of Sodium butyrate information most frequently consulted were the primary care medical records and patients themselves. The primary care record was the only source of information that was consulted significantly more frequently at re-audit, compared with baseline, and this source also yielded the highest proportion of discrepancies. Medicines reconciliation as a source of medication error Of the total national sample for whom two or more sources of information had been checked, discrepancies were identified in 25% at baseline, and 31% at re-audit.