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Medications reconciliation following admission of patient to Leeds Teaching Hospital

Use case for medications reconciliation following admission of patient to Leeds Teaching Hospital

Brief description

Upon admission to the acute hospital, all medications the patient is currently taking need to be gathered for review in a medication reconciliation. All current medication will be entered into the MedChart system to be reviewed by a pharmacist and/or clinician to determine what the patient needs to continue taking whilst an inpatient and what needs to be discontinued.

Use case justification

Clinical and administration:

  • Access to accurate information at the point of care reducing the opportunity for errors to occur.
  • Reduction in transcription between systems and paper to IT, leading to a reduction in errors.
  • Reduction in clinical time wasted, away from the patient, collecting and collating information.
  • Reduction in clinical time wasted, away from the patient, manually updating IT systems.
  • Reducing the paper flow through departments by utilising the system workflow to manage tasks using staff time efficiently.


  • Security of patient information is maintained and improved through the reduction of paper-based ‘patient identifiable documents’ in use within departments.
  • Increased patient/clinician time due to reduction in clinician time spent collecting and transcribing information away from the patient.
  • Increased patient safety due to the reduction in manual transcription errors.
  • Better patient experience as they are not being asked for information which should already be available to the clinician.

Primary actors

  • Pharmacy technician
  • Pharmacist
  • Clinician
  • MedChart system
  • GP Connect
  • GP clinical system

Secondary actors

  • Patient


  • Patient is admitted to Leeds Teaching Hospitals.


  • The patient’s details have been verified and entered on the hospital system.
  • Hospital staff have the correct/appropriate system access rights.
  • The patient’s GP has agreed to share patient information via GP Connect.
  • The patient allows this shared information to be viewed/used by hospital staff.
  • Electronic interactions between hospital system(s)/GP Connect/GP clinical system have been correctly configured.


  • On success:
    • Clinical information is imported and recorded against the local patient record.
  • Guaranteed:
    • All the relevant available information on the patient’s medical history has been recorded on the MedChart system.

Basic flow with alternative and exception flows

Step Description
Step 1 Patient is admitted to the hospital.
Step 2 Pharmacy technician will log onto MedChart to enter the patient’s record.
Step 3 The MedChart system will request the patient’s current medications and allergies that are held in the GP practice system via the GP Connect service.
Step 4 GP Connect and the GP practice system will check that Leeds Teaching Hospitals is allowed access to the data and that the patient has not objected to their data being shared.
Step 5

GP clinical system provides all current medications and allergies.

This will include:

  • Acute medications

  • Current repeat medication issues

  • Medication marked as prescribed elsewhere

    • Including dosage of medications in mg

  • Allergies

  • Level of reaction

  • What reaction occurs

  • When allergy was reported

Other information that would be useful:

  • Current problems and diagnosis

  • Current referrals

  • Vaccinations

  • Compliance aids

  • Preferred pharmacy

  • Carer information

  • Clinic appointments

Step 6 MedChart imports the all information supplied from the GP practice. This data is now available for clinicians to review and maintain.
Step 7 The pharmacy technician will gather any additional information they can about the medications the patient is currently taking.
Step 8 The medical data retrieved by the pharmacy technicians from other sources is manually added to the MedChart system.
Step 9 The clinician reviews the medication with the patient and makes any required corrections.
Alternative path
Step 5a

Where there are not the appropriate permissions to share the data, GP Connect returns an error message saying the information cannot be returned.

The pharmacy technician will retrieve the information using the Summary Care Record (SCR), Leeds Care Record and direct requests to the GP practice. They will then manually enter the data.

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