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Background Medication Reconciliation involves creating the most accurate list of medications that a patient is taking, with the patient/family member/caregiver being the first point of information. The main aim of this audit was to ascertain what proportion of patients attending outpatient appointments, brought an up-to-date list of their medications. Methods The audit was conducted using two anonymous, unlinked questionnaires, one completed by patients/caregivers, another completed by Doctors/Candidate Advanced Nurse Practitioners (cANP). Data was collected between 6/11/18 – 9/11/18 and incorporated Memory Clinics, General Geriatric Clinics and Hypertension/Stroke Clinics. 54 patient questionnaires and 53 Doctor/cANP questionnaires were completed. Results 67% of patients reported having an up-to-date list of medications. 62% of doctors/cANP felt the patient had an up-to-date list. The majority of patients were aged 71-80, on 5-10 medications and felt that their GP had the most up-to-date list of their medications. Only 17% of patients reported that they themselves had the most up-to-date list of their medications. Where patients did not have an up-to-date list, Doctors/cANPs compiled a list by phoning the Pharmacy in 50% of cases and referring to previous clinic letters in 30% of cases. 34% of patients had medications changed at their clinic visit. Conclusion This audit shows that roughly one third of patients do not bring up-to-date lists of medications to their outpatient appointments and only a small proportion of patients feel that they themselves have the most up-to-date list of their own medications. Suggested areas for improvement include patient education campaigns, reminder letters/text messages to patients prior to their clinic appointments and the introduction of a Clinical Pharmacist to the outpatient setting. [ABSTRACT FROM AUTHOR]

Background While hypertension is the leading cause of stroke, early blood pressure (BP) management post event can be a challenge. Adjustment of antihypertensive medications is largely based on daytime ward readings. Abnormal nocturnal BP patterns may go undetected with increased risk to the patients from either extreme of BP. 24-hour ABPM has been shown to provide additional prognostic information over routine clinic measurements. We evaluated stroke patients for abnormal circadian BP profiles early after their event. Methods Patients admitted with a stroke, whose BP had normalised for at least 48 hours, were invited to participate. ABPM was fitted for 24 hours and readings compared with routine ward BP measurements. Daytime BP was calculated between 9am-9pm; nighttime midnight-6am. Additional information was gathered on medical history, cardiovascular risks and neuroimaging. Results Twenty-nine patients were recruited (median 6 days post event) with mean age 70.5, 62% male. The majority (86.2%) had ischaemic stroke or TIA. Seventeen had diagnosed hypertension and were taking median of 2 medications. Mean baseline ward systolic BP was 129mmHg (range 104-148 mmHg). Mean systolic BP on ABPM was 126mmHg (range 92-154 mmHg) and 123mmHg (range 93-181 mmHg) for daytime and nighttime respectively. Patients with a history of atrial fibrillation (N=13) had a higher prevalence of a non-dipping pattern, with an average 10.4 mmHg rise in their nighttime systolic BP compared with a 3mmHg fall in those without atrial fibrillation (p = 0.011). They also exhibited greater BP variability. Conclusion In this pilot study, through the use of early ABPM we found high rates of non-dipping nocturnal BP in patients following stroke, particularly in those with underlying atrial fibrillation. The availability of 24-hour BP might allow for more individualised antihypertensive management particularly at this high-risk acute stage. Furthermore the presence of abnormal circadian patterns might be a marker for conditions such as atrial fibrillation and obstructive sleep apnoea that compound stroke risk. [ABSTRACT FROM AUTHOR]