Background

Transitions in care between hospital and community settings can pose risks to patient safety – particularly medication errors.

To reduce these risks, it’s important that medicines documentation be successfully transferred across care settings. And medicines reconciliation – the act of resolving discrepancies in medication lists at care boundaries – is one key strategy to achieve that.

Medicines reconciliation is recommended by NICE for all patients undergoing hospital admission, intra-hospital transfer, and discharge back into the community. But recent reviews have concluded that its effect on clinical outcomes, such as hospital re-admission, is still uncertain.

Evidence suggests that the implementation of medicines reconciliation may be at fault, rather than its effectiveness. And successful implementation strategies must be sensitive to the local context of the clinical setting.

Approach

To understand how to improve medicines reconciliation, this project will use an “exnovation” approach. Instead of the traditional approach of quantifying errors and developing interventions to correct them, exnovation identifies the hidden competences of existing practices that mitigate against errors in the first place.

Video-reflexive ethnography (VRE) is one method that applies this approach to understanding and improving patient care. This project aims to be the first VRE study to examine the context of medicines reconciliation in NHS Scotland.