01 the business
Acute hospital pharmacy team
40 pharmacists, 500 beds
On admission, pharmacists check each patient's medicines against GP records, previous letters, care home charts and what the patient says. Gathering the sources often takes longer than the clinical check.
02 before
The problem
When patients are admitted or move between services, their medicines must be checked against every source: GP records, discharge letters, care home charts and what the patient says. Gathering the sources takes pharmacists' time before the clinical work even starts.
- Sources are gathered by hand for every admission.
- Differences between sources are found line by line.
- Reconciliation is delayed for weekend admissions.
03 the build
What the AI does
- Step 1: Collects medication information from the sources available, such as GP records, previous discharge letters and care home charts.
- Step 2: Lines up the medicines from each source in one table, with dose, frequency and when each was last recorded.
- Step 3: Highlights differences between sources, such as a dose change or a medicine on one list but not another.
- Step 4: Notes where each entry came from and how recent it is.
- Step 5: Places the table in the pharmacist's worklist for reconciliation.
paused: waiting for a person to approve
How it was put together
- Collected medication information from available sources.
- Lined up medicines in one table with dose, frequency and date last recorded.
- Highlighted differences between sources.
- Placed the table in the pharmacist's worklist with the source of each entry.
04 human in the loop
Where a person stays in charge
A pharmacist or clinician reconciles every list and makes every decision about medicines. The tool gathers and compares; it never recommends starting, stopping or changing a medicine.
- Pharmacists reconcile every list and make every medicine decision.
- The tool never recommends starting, stopping or changing a medicine.
- Each entry shows its source and age.
05 rollout
From kickoff to live in 10–12 weeks
- Weeks 1–4Connect sources, clinical safety review and pharmacist-designed layout.
- Weeks 5–8Pilot on the admissions unit.
- Weeks 9–12Extend to other admitting wards.
06 after
What changes
Pharmacists start reconciliation with the sources already gathered and differences highlighted, so more of their time goes on clinical checks.
Assume 90 admissions a day and 15 minutes of pharmacist time gathering sources for each, halved by preparation.
90 × 7.5 minutes = 675 minutes, or about 11 pharmacist hours a day moved to clinical checks.
What to measure
- Time from admission to reconciliation.
- Pharmacist time per reconciliation.
- Discrepancies found and resolved.
- Medication incidents linked to admission.
07 evidence
What the research says
The global cost of medication errors has been estimated at US$42 billion a year.
World Health Organization, Medication Without Harm (opens in a new tab) · 2017
Around 1 in 10 patients is harmed in health care, and more than half of that harm is preventable.
World Health Organization, Patient safety fact sheet (opens in a new tab) · 2023
08 lessons
Mistakes to avoid
- Treating the table as reconciled. It is the starting point.
- Stale sources. Show how old each entry is.
- Skipping the patient. What they actually take matters most.
09 questions
Common questions
- Why focus on medicines?
- WHO estimates medication errors cost US$42 billion a year globally, and transitions of care are a common point of error.
- Does it work for care homes?
- Yes. It can compare eMAR charts with GP and hospital records for the visiting pharmacist.