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Klasing S, Jungreithmayr V, Morath B, Scherkl C, Meid AD, Haefeli WE, Seidling HM. [Quality of medication documentation in patientś discharge summaries after implementing new legal requirements]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2024:S1865-9217(24)00093-X. [PMID: 38918158 DOI: 10.1016/j.zefq.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/27/2024] [Accepted: 05/06/2024] [Indexed: 06/27/2024]
Abstract
INTRODUCTION Discharge from hospital is a risk to drug continuity and medication safety. In Germany, new legal requirements concerning the management of patient discharge from the hospital came into force in 2017. They set minimum requirements for the documentation of medications in patient discharge summaries, which are the primary means of communication at transitions of care. Six years later, data on their practical implementation in routine care are lacking. METHODS Within the scope of an explorative retrospective observational study, the minimum requirements were operationalized and a second set of assessment criteria was derived from the recommendation "Good Prescribing Practice in Drug Therapy" published by the Aktionsbündnis Patientensicherheit e.V. as a comparative quality standard. A sample of discharge summaries was drawn from routine care at the University Hospital Heidelberg and assessed according to their fulfilment of the criteria sets. In addition, the potential influence of certain context factors (e. g., involvement of clinical pharmacists or software usage) was evaluated. RESULTS In total, 11 quality criteria were derived from the minimum requirements. According to the eligibility criteria (i. e., three or more discharge medications) 352 discharge summaries (42 wards; issued in May-July 2021), containing in total 3,051 medications, were included. The practical implementation of the minimum requirements for documenting medications in patient discharge summaries differed considerably depending on the criterion and defined context factors. Core elements (i. e., drug name, strength, and dosage at discharge) were fulfilled in 82.8 %, while further minimum requirements were rarely met or completely lacking (e. g., explanations for special pharmaceutical forms). Involvement of clinical pharmacists and usage of software were shown to be a facilitator of documentation quality, while on-demand medication (compared to long-term medication) as well as newly prescribed medication (compared to home medication or medication changed during hospitalisation) showed poorer documentation quality. In addition, the documentation quality seemed to depend on the department and the day of discharge. CONCLUSION To date, the wording of the German legal requirements allows for different interpretations without considering the respective clinical setting and the medication actually prescribed. For future clarification of the requirements, implications of the wording for the clinical setting should be considered.
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Affiliation(s)
- Sophia Klasing
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Viktoria Jungreithmayr
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Benedict Morath
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Apotheke des Universitätsklinikums Heidelberg, Heidelberg, 69120, Deutschland
| | - Camilo Scherkl
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Andreas D Meid
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Walter E Haefeli
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Hanna M Seidling
- Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland; Universität Heidelberg, Medizinische Fakultät Heidelberg / Universitätsklinikum Heidelberg, Innere Medizin IX - Abteilung für Klinische Pharmakologie und Pharmakoepidemiologie, Kooperationseinheit Klinische Pharmazie, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland.
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Jeffery S, Monkhouse J, Bertini L, Walker S, Sharp R. Discharge to Assess: an evaluation of three case studies in the southeast of England to inform service improvement. BMJ Open Qual 2023; 12:e002515. [PMID: 38114247 DOI: 10.1136/bmjoq-2023-002515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 12/02/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Discharge to Assess (D2A) emerged as a critical process during the COVID-19 pandemic facilitating patient flow within hospitals, however research on the post-discharge community services of this pathway remains limited. We conducted an evaluation to examine the impacts, capacity, processes and barriers associated with D2A and to identify best practice across three sites in the southeast of England. METHODS We interviewed 29 commissioners, providers and staff members involved in the delivery of D2A pathways within three Health and Care Partnerships. Framework analysis of the collected data revealed three prominent themes: the commissioning of services encompassing funding, structure, culture, and expected outcomes; multidisciplinary collaboration including staff skills, team connections, and coordination; and information and knowledge exchange such as assessment methods, record management, and availability of operational insights. RESULTS 62 specific enablers and blockers to effective D2A practice emerged. DISCUSSION These findings supported the development of a comprehensive service improvement toolkit. CONCLUSION Five recommendations are proposed: 1. Examination of pathways against the 62 enablers and blockers to identify and resolve pathway obstacles; 2. Establish a local operational policy accessible to all providers; 3. Enhance coordination and communication among service providers, patients and carers; 4. Strengthen oversight of service user flow; 5. Develop a consistent Patient Reported Outcomes Measure to facilitate feedback and service enhancements for individuals discharged from urgent care pathways.
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Affiliation(s)
- Stuart Jeffery
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- NIHR Applied Research Collaboration Kent Surrey Sussex, Hove, UK
| | - Jenny Monkhouse
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Lavinia Bertini
- NIHR Applied Research Collaboration Kent Surrey Sussex, Hove, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Susie Walker
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Rebecca Sharp
- Kent Surrey Sussex Academic Health Science Network, Crawley, UK
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Zahl-Holmstad B, Garcia BH, Svendsen K, Johnsgård T, Holis RV, Ofstad EH, Risør T, Lehnbom EC, Wisløff T, Chan M, Elenjord R. Completeness of medication information in admission notes from emergency departments. BMC Health Serv Res 2023; 23:1425. [PMID: 38104071 PMCID: PMC10724918 DOI: 10.1186/s12913-023-10371-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/22/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness. METHODS Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness. RESULTS Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient's living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness. CONCLUSIONS Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.
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Affiliation(s)
- Birgitte Zahl-Holmstad
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway.
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway.
| | - Beate H Garcia
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Kristian Svendsen
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Tine Johnsgård
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renata V Holis
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
| | - Eirik H Ofstad
- Department of Medicine, Nordland Hospital Trust, Parkveien 95, Bodø, 8005, Norway
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Torsten Risør
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, 1014, Denmark
| | - Elin C Lehnbom
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Universitetsplatsen 1, Kalmar, 392 31, Sweden
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Sykehusveien 25, Nordbyhagen, Lørenskog, 1478, Norway
| | - Macty Chan
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
| | - Renate Elenjord
- Hospital Pharmacy of North Norway Trust, Postboks 6147, Langnes, Tromsø, 9291, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050, Langnes, Tromsø, 9037, Norway
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Henriksen BT, Krogseth M, Andersen RD, Davies MN, Nguyen CT, Mathiesen L, Andersson Y. Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. J Orthop Surg Res 2023; 18:434. [PMID: 37312222 DOI: 10.1186/s13018-023-03906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. METHODS Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. RESULTS The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (- 0.44 (95% confidence interval - 0.72, - 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients). CONCLUSION The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy. TRIAL REGISTRATION NCT03695081.
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Affiliation(s)
- Ben Tore Henriksen
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway.
- Division of Surgery, Vestfold Hospital Trust, Tonsberg, Norway.
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway.
| | - Maria Krogseth
- Old Age Psychiatry Research Network, Telemark Vestfold, Vestfold Hospital Trust, Tonsberg, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maren Nordsveen Davies
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
| | - Caroline Thy Nguyen
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Tromso, Tromso, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Yvonne Andersson
- Research Department, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
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Henriksen BT, Krogseth M, Nguyen CT, Mathiesen L, Davies MN, Andersen RD, Andersson Y. Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians' experience and a review of patient records. BMJ Open 2022; 12:e064868. [PMID: 36379642 PMCID: PMC9668037 DOI: 10.1136/bmjopen-2022-064868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Patients with hip fracture are at high risk of medication errors due to a combination of high age, comorbidities, polypharmacy and several care transitions after fracture. The aim was to study medication management tasks concerning patient safety: medication reconciliation, medication review and communication of key medication information in care transitions. DESIGN Descriptive study comprising a self-administered clinician survey (MedHipPro-Q) and a retrospective review of hospital medical records of patients with hip fracture. SETTING Regional hospital and the associated primary care units (South-Eastern Norway). PARTICIPANTS The survey received responses from 253 clinicians, 61 medical doctors and 192 nurses, involved in the medication management of patients with hip fracture, from acute admittance to the regional hospital, through an in-hospital fast track, primary care rehabilitation and back to permanent residence. Respondents' representativeness was unknown, introducing a risk of selection and non-response bias, and extrapolating findings should be done with caution. The patient records review included a random sample of records of patients with hip fracture (n=50). OUTCOME MEASURES Medication reconciliation, medication review and communication of medication information from two perspectives: the clinicians' (ie, experiences with medication management) and the practice (ie, documentation of completed medication management). RESULTS In the survey, most clinicians stated they performed medication reconciliation (79%) and experienced that patients often arrived without a medication list after care transition (37%). Doctors agreed that more patients would benefit from medication reviews (86%). In the hospital patient records, completed medication reconciliation was documented in most patients (76%). Medication review was documented in 2 of 50 patients (4%). Discharge summary guidelines were followed fully for 3 of 50 patients (6%). CONCLUSION Our study revealed a need for improved medication management for patients with hip fracture. Patients were at risk of medication information not being transferred correctly between care settings, and medication reviews seemed to be underused in clinical practice.
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Affiliation(s)
- Ben Tore Henriksen
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Division of Surgery, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maria Krogseth
- Old Age Psychiatry Research Network, Telemark Vestfold, Vestfold Hospital Trust, Tonsberg, Norway
- Department of Nursing and Health Science, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
- Department of Internal Medicine, Telemark Hospital Trust, Skien, Norway
| | - Caroline Thy Nguyen
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Liv Mathiesen
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Maren Nordsveen Davies
- Tonsberg Hospital Pharmacy, Hospital Pharmacies Enterprise, South Eastern Norway, Tonsberg, Norway
| | - Randi Dovland Andersen
- Department of Research, Telemark Hospital Trust, Skien, Norway
- Research Centre for Habilitation and Rehabilitation Models & Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Yvonne Andersson
- Department of Research, Hospital Pharmacies Enterprise, South Eastern Norway, Oslo, Norway
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Sheehan J, Lannin NA, Laver K, Reeder S, Bhopti A. Primary care practitioners' perspectives of discharge communication and continuity of care for stroke survivors in Australia: A qualitative descriptive study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2530-e2539. [PMID: 34957626 DOI: 10.1111/hsc.13696] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/06/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Discharge communication is an important component of care transition between hospitals and community care, particularly for the complex needs of stroke survivors. Despite international research and regulation, ineffective information exchange during care transitions continues to compromise patient outcomes. Primary care practitioners are increasingly responsible for the provision of stroke care in the community, yet it is not known how their role is supported by discharge communication. The aim of this qualitative study was to describe the primary care practitioner perspective of discharge communication, identifying the barriers and enablers relative to continuity of care for stroke survivors. Semi-structured telephone interviews were conducted with primary care practitioners across Australia, between April and September 2020. Data were analysed using thematic analysis with a constant-comparison approach. The findings suggest that discharge communication is often inadequate for the complex care and recovery needs of stroke survivors. The challenges in accessing care plans were noted barriers to continuity of care, while shared understandings of stroke survivors' needs were identified as enablers. As discharge communication processes were perceived to be disconnected, primary care practitioners suggested a team approach across care settings. It is concluded that initiatives are required to increase primary care collaboration with hospital teams (which include stroke survivors and their caregivers) to improve continuity of care after stroke.
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Affiliation(s)
| | - Natasha A Lannin
- La Trobe University, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
| | - Kate Laver
- Flinders University, Adelaide, South Australia, Australia
| | | | - Anoo Bhopti
- La Trobe University, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
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Jeffries M, Keers RN, Belither H, Sanders C, Gallacher K, Alqenae F, Ashcroft DM. Understanding the implementation, impact and sustainable use of an electronic pharmacy referral service at hospital discharge: A qualitative evaluation from a sociotechnical perspective. PLoS One 2021; 16:e0261153. [PMID: 34936661 PMCID: PMC8694480 DOI: 10.1371/journal.pone.0261153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/28/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The transition of patients across care settings is associated with a high risk of errors and preventable medication-related harm. Ensuring effective communication of information between health professionals is considered important for improving patient safety. A National Health Service(NHS) organisation in the North West of England introduced an electronic transfer of care around medicines (TCAM) system which enabled hospital pharmacists to send information about patient’s medications to their nominated community pharmacy. We aimed to understand the adoption, and the implications for sustainable use in practice of the TCAM service Methods We evaluated the TCAM service in a Clinical Commissioning Group (CCG) and NHS Foundation Trust in Salford, United Kingdom (UK). Participants were opportunistically recruited to take part in qualitative interviews through stakeholder networks and during hospital admission, and included hospital pharmacists, hospital pharmacy technicians, community pharmacists, general practice-based pharmacists, patients and their carers. A thematic analysis, that was iterative and concurrent with data collection, was undertaken using a template approach. The interpretation of the data was informed by broad sociotechnical theory. Results Twenty-three interviews were conducted with health care professionals patients and carers. The ways in which the newly implemented TCAM intervention was adopted and used in practice and the perceptions of it from different stakeholders were conceptualised into four main thematic areas: The nature of the network and how it contributed to implementation, use and sustainability; The material properties of the system; How work practices for medicines safety were adapted and evolved; and The enhancement of medication safety activities. The TCAM intervention was perceived as effective in providing community pharmacists with timely, more accurate and enhanced information upon discharge. This allowed for pharmacists to enhance clinical services designed to ensure that accurate medication reconciliation was completed, and the correct medication was dispensed for the patient. Conclusions By providing pharmacy teams with accurate and enhanced information the TCAM intervention supported healthcare professionals to establish and/or strengthen interprofessional networks in order to provide clinical services designed to ensure that accurate medication reconciliation and dispensing activities were completed. However, the intervention was implemented into a complex and at times fragmented network, and we recommend opportunities be explored to fully integrate this network to involve patients/carers, general practice pharmacists and two-way communication between primary and secondary care to further enhance the reach and impact of the TCAM service.
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Affiliation(s)
- Mark Jeffries
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- * E-mail:
| | - Richard N. Keers
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Pharmacy Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | | | - Caroline Sanders
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
- Division of Population Health, Health Services Research & Primary Care University of Manchester, Manchester, United Kingdom
| | - Kay Gallacher
- Patient and Public Involvement, NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
| | - Fatema Alqenae
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Darren M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, United Kingdom
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester Academic Health Sciences Centre (MAHSC), Manchester, United Kingdom
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How can communication to GPs at hospital discharge be improved? A systems approach. BJGP Open 2021; 6:BJGPO.2021.0148. [PMID: 34620598 PMCID: PMC8958742 DOI: 10.3399/bjgpo.2021.0148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/12/2021] [Indexed: 11/05/2022] Open
Abstract
Background Poor communication to GPs at hospital discharge threatens patient safety and continuity of care, with reliance on discharge summaries that are commonly written by the most junior doctors. Previous quality improvement efforts have largely focused on adherence to standardised templates, with limited success. A lack of understanding has been identified as a cause of the issue’s resistance to decades of improvement work. Aim To understand the system of communication to GPs at hospital discharge, with a view to identifying potential routes to improvement. Design & setting A qualitative exploration of the secondary-to-primary care communication system surrounding a large UK hospital. Method A systems approach, recently defined for the healthcare domain, was used to structure and thematically analyse interviews (n = 18) of clinical and administrative staff from both sides of the primary–secondary care interface, and a subsequent focus group. Results The largely one-way communication system structure and the low level of hospital stakeholder insight into recipient GP needs emerged as consistent hindrances to system performance. More open lines of communication and shared records might enable greater collaboration to share feedback and resolve informational deficits. Teaching sessions and assessments for medical students and junior doctors led by GPs could help to instil the importance of detail and nuance when using standardised communication templates. Conclusion Facilitating the sharing of performance insights between stakeholder groups emerged as the key theme of how communication might be improved. The empirical measures proposed have the potential to mitigate the safety risks of key barriers to performance such as patient complexity.
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Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study. Pediatr Qual Saf 2021; 6:e456. [PMID: 34476308 PMCID: PMC8389964 DOI: 10.1097/pq9.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Many children are discharged from the pediatric emergency department (PED) with incomplete or inappropriate instructions following a concussion. Our objective was to evaluate the effectiveness of a simple intervention in improving discharge instruction disbursement and completeness following PED diagnosis of concussion. Methods A pre/post intervention study of 935 patients (375 preintervention and 560 postintervention) ages 5-19, diagnosed with a concussion and discharged from the PED between July 2016 and November 2019, was performed at a single United States pediatric tertiary-care center. Dedicated provider education sessions were held, and a consensus guideline-based set of discharge instructions were implemented in the electronic health record. Primary outcomes included the presence of return-to-play (RTP) instructions, return-to-learn (RTL) instructions, follow-up recommendations, and "complete" discharge (ie, all 3 components present). Statistical process control charts were generated and tested for special cause variation. Results More patients received instructions for RTP (87% versus 59%) and RTL (60% versus 3%), and a complete discharge was more frequent (45% versus 2%), following the conclusion of the intervention. Only the improvement in RTP instructions was completely sustained into the following academic year, whereas RTL and complete discharge rates declined to 27% and 20%, respectively. Conclusions A simple, low-cost intervention such as peer-to-peer education and consensus guideline-based discharge instruction templates can significantly improve discharge readiness after pediatric concussion. Further work is needed to maintain progress and continue improvements, at our large academic trauma center.
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Millares Martin P. Non-systematic review: Correspondence quality and interoperability between family physicians and hospital clinicians. Int J Clin Pract 2021; 75:e13984. [PMID: 33484081 DOI: 10.1111/ijcp.13984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 01/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Medical correspondence between physicians working in the community and in hospital is paramount to provide continuity of care, but there is no agreement on what constitutes a good quality letter, not even interest by some clinicians on this interface. Information flow could be faster electronically rather than in paper, but is content improving? What defines a good letter? AIM (a) To assess what information should be shared between family doctors and hospital physicians and could it be shared better. (b) To assess the possibility of linking the sections of the letter to SNOMED-CT codes to improve interoperability. RESULTS Authors vary regarding what is to be included in communications, and as they also have different needs among services, it creates a very long list of possible items to consider. Standardised templates with their corresponding SNOMED-CT codes are presented. CONCLUSION Standardised correspondence could improve continuity of care. Appropriately coded it could facilitate the information sharing and the data manipulation required to provide an adequate provision of services among primary care or family physicians and hospitals or secondary care organisations. It could also serve as a tool to assess clinicians' performance.
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11
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Pedersen RA, Petursson H, Hetlevik I, Thune H. Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration. BMC Health Serv Res 2021; 21:41. [PMID: 33413305 PMCID: PMC7792345 DOI: 10.1186/s12913-020-06021-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 12/16/2020] [Indexed: 12/02/2022] Open
Abstract
Background The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. Methods The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis. Results We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. Conclusions The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.
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Affiliation(s)
- Rune Aakvik Pedersen
- Department of Public Health and Nursing, General Practice Research Unit, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Halfdan Petursson
- Department of Public Health and Nursing, General Practice Research Unit, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Irene Hetlevik
- Department of Public Health and Nursing, General Practice Research Unit, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henriette Thune
- Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
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12
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Troude P, Nieto I, Brion A, Goudinoux R, Laganier J, Ducasse V, Nizard R, Martinez F, Segouin C. Assessing the impact of a quality improvement program on the quality and timeliness of discharge documents: A before and after study. Medicine (Baltimore) 2020; 99:e23776. [PMID: 33371146 PMCID: PMC7748348 DOI: 10.1097/md.0000000000023776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022] Open
Abstract
Whereas handover of pertinent information between hospital and primary care is necessary to ensure continuity of care and patient safety, both quality of content and timeliness of discharge summary need to be improved. This study aims to assess the impact of a quality improvement program on the quality and timeliness of the discharge summary/letter (DS/DL) in a University hospital with approximatively 40 clinical units using an Electronic medical record (EMR).A discharge documents (DD) quality improvement program including revision of the EMR, educational program, audit (using scoring of DD) and feedback with a ranking of clinical units, was conducted in our hospital between October 2016 and November 2018. Main outcome measures were the proportion of the DD given to the patient at discharge and the mean of the national score assessing the quality of the discharge documents (QDD score) with 95% confidence interval.Intermediate evaluation (2017) showed a significant improvement as the proportion of DD given to patients increased from 63% to 85% (P < .001) and mean QDD score rose from 41 (95%CI [36-46]) to 74/100 (95%CI [71-77]). In the final evaluation (2018), the proportion of DD given to the patient has reached 95% and the mean QDD score was 82/100 (95% CI [80-85]). The areas of the data for admission and discharge treatments remained the lowest level of compliance (44%).The involvement of doctors in the program and the challenge of participating units have fostered the improvement in the quality of the DD. However, the level of appropriation varied widely among clinical units and completeness of important information, such as discharge medications, remains in need of improvement.
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Affiliation(s)
| | | | - Annie Brion
- Direction des Usagers, du Système d’Information et de la Qualité
| | | | | | | | - Rémy Nizard
- Service de chirurgie orthopédique, HU Saint-Louis – Lariboisière – Fernand Widal, AP-HP, Paris, France
| | - Fabien Martinez
- Direction des Usagers, du Système d’Information et de la Qualité
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13
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Abdulla S, Simon N, Woodhams K, Hayman C, Oumar M, Howroyd LR, Sethi GC. Improving the quality of clinical coding and payments through student doctor-coder collaboration in a tertiary haematology department. BMJ Open Qual 2020; 9:bmjoq-2019-000723. [PMID: 32198235 PMCID: PMC7103790 DOI: 10.1136/bmjoq-2019-000723] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/28/2020] [Accepted: 02/07/2020] [Indexed: 11/03/2022] Open
Abstract
Hospitals within the UK are paid for services provided by 'Payment-by-Results'. In a system that rewards productivity, effective collaboration between coders and clinicians is crucial. However, clinical coding is frequently error prone and has been shown to impact negatively on departmental revenue. Our aim was to increase the median number of diagnostic codes per sickle cell inpatient admission at Guy's Hospital by 3. Three interventions were implemented using the Plan, Do, Study, Act structure. This consisted of student doctors searching for diagnoses along with comorbidities that clinical coders had missed, distributing laminated cards with common clinical codes and implementing discharge pro formas. Through auditing, student doctors generated a total of £58 813 over 16 weeks. We observed an increase in the median number of codes by ≥2 additional codes. We improved coding accuracy where we identified errors in an average of 32.5% of admissions each month, improving the quality of patient documentation. We have demonstrated student doctor involvement in clinical coding as a potentially sustainable means of achieving accurate payment for services provided; increasing departmental revenue. We are the first to report the efficacy of student-coder collaboration in improving the accuracy of clinical coding.
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Affiliation(s)
- Suha Abdulla
- School of Medical Education, King's College London, London, UK
| | - Natalie Simon
- School of Medical Education, King's College London, London, UK
| | - Kelvin Woodhams
- School of Medical Education, King's College London, London, UK
| | - Carla Hayman
- Clinical Coding Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Mohamed Oumar
- School of Medical Education, King's College London, London, UK
| | | | - Gulshan Cindy Sethi
- School of Medical Education, King's College London, London, UK.,Guy's and Saint Thomas' NHS Foundation Trust, London, UK
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14
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Shah C, Hough J, Jani Y. Medicines reconciliation in primary care: a study evaluating the quality of medication-related information provided on discharge from secondary care. Eur J Hosp Pharm 2020; 27:137-142. [PMID: 32419933 DOI: 10.1136/ejhpharm-2018-001613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/17/2018] [Accepted: 09/06/2018] [Indexed: 11/03/2022] Open
Abstract
Objectives Medicines reconciliation is an effective way of reducing errors at transitions of care. Much of the focus has been on medicines reconciliation at point of admission to hospital. Our objective was to evaluate medicines reconciliation after discharge from hospital by assessing the quality of information regarding medicines within discharge summaries and determining whether the information provided regarding medicines changes were acted on within 7 days of receiving the discharge information. Methods A retrospective collaborative evaluation of medicines-related discharge information by Clinical Commissioning Group (CCG) pharmacists using standardised data collection tools. Outcomes of interest included compliance with national minimum standards for medication-related information on discharge summaries, such as allergies, changes to medication regimen, minimum prescription standards, for example, dose, route, formulation and duration, and medicines reconciliation by the primary care team. Data were analysed centrally. Results 43 CCGs covering each of the four National Health Service regions in England participated in the study and submitted data for 1454 patients and 10 038 prescribed medicines. The majority of medication details were stated in accordance with standards with the exception of indication (11.7% compliance), formulation (60.3% compliance) and instructions of ongoing use (72.5% compliance). Documentation about changes was poor: 1550/3164 (49%) newly started medicines, 186/477 (39%) dose changes and 420/738 (57%) stopped medicines had a reason documented. Changes were not acted on within 7 days of receiving the discharge information for 12.5% of patients. Conclusions Our evaluation revealed overall good compliance with discharge medication documentation standards, but a number of changes to medicines during hospitalisation were not fully communicated or documented on the discharge summary or actioned in the general practice after discharge.
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Affiliation(s)
- Chetan Shah
- Pharmacy Department, Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Jane Hough
- Medicines Use and Safety, NHS Specialist Pharmacy Service, London, UK
| | - Yogini Jani
- UCLH NHS Foundation Trust, UCL School of Pharmacy, London, UK.,UCLH-UCL Centre for Medicines Optimisation Research and Education, London, UK
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15
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Dinsdale E, Hannigan A, O'Connor R, O'Doherty J, Glynn L, Casey M, Hayes P, Kelly D, Cullen W, O'Regan A. Communication between primary and secondary care: deficits and danger. Fam Pract 2020; 37:63-68. [PMID: 31372649 DOI: 10.1093/fampra/cmz037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Timely and accurate communication between primary and secondary care is essential for delivering high-quality patient care. OBJECTIVE The aim of this study is to evaluate the content contained in both referral and response letters between primary and secondary care and measure this against the recommended national guidelines. METHODS Using an observational design, senior medical students and their general practice supervisors applied practice management software to identify 100 randomly selected adults, aged greater than 50 years, from a generated list of consults over a 2-year period (2013-2015). All data included in referral and response letters for these adults were examined and compared with the gold standard templates that were informed by international guidelines. RESULTS Data from 3293 referral letters and 2468 response letters from 68 general practices and 17 hospitals were analysed. The median time that had elapsed between a patient being referred and receiving a response letter was 4 weeks, ranging from 1 week for Emergency Department referral letters to 7 weeks for orthopaedic surgery referral letters. Referral letters included the reason for referral (98%), history of complaint (90%) and current medications (82%). Less commonly included were management prior to referral (65%) and medication allergies (57%). The majority of response letters included information on investigations (73%), results (70%) and follow-up plan (85%). Less commonly, response letters included medication changes (30%), medication lists (33%) and secondary diagnoses (13%). CONCLUSIONS Future research should be aimed at developing robust strategies to addressing communication gaps reported in this study.
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Affiliation(s)
- Elsa Dinsdale
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ray O'Connor
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Peter Hayes
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dervla Kelly
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
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Elliott RA, Tan Y, Chan V, Richardson B, Tanner F, Dorevitch MI. Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability. PHARMACY 2019; 8:pharmacy8010002. [PMID: 31905902 PMCID: PMC7151653 DOI: 10.3390/pharmacy8010002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 12/16/2019] [Accepted: 12/27/2019] [Indexed: 11/16/2022] Open
Abstract
Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2-16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.
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Affiliation(s)
- Rohan A. Elliott
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3052, Australia
- Correspondence: ; Tel.: +61-9496-2334
| | - Yixin Tan
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
- Pharmacy Department, Waitemata District Health Board, Auckland 0620, New Zealand
| | - Vincent Chan
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
- School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
| | - Belinda Richardson
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
| | - Francine Tanner
- Pharmacy Department, Austin Health, Heidelberg, VIC 3084, Australia; (Y.T.); (V.C.); (B.R.); (F.T.)
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Weetman K, Dale J, Scott E, Schnurr S. The Discharge Communication Study: research protocol for a mixed methods study to investigate and triangulate discharge communication experiences of patients, GPs, and hospital professionals, alongside a corresponding discharge letter sample. BMC Health Serv Res 2019; 19:825. [PMID: 31711500 PMCID: PMC6849198 DOI: 10.1186/s12913-019-4612-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 10/03/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Discharge letters are crucial during care transitions from hospital to home. Research indicates a need for improvement to increase quality of care and decrease adverse outcomes. These letters are often sent from the hospital discharging physician to the referring clinician, typically the patient's General Practitioner (GP) in the UK, and patients may or may not be copied into them. Relatively little is known about the barriers and enablers to sending patients discharge letters. Hence, the aim of this study was to investigate from GP, hospital professional (HP) and patient perspectives how to improve processes of patients receiving letters and increase quality of discharge letters. The study has a particular focus on the impacts of receiving or not receiving letters on patient experiences and quality of care. METHODS The setting was a region in the West Midlands of England, UK. The research aimed to recruit a minimum of 30 GPs, 30 patients and 30 HPs in order to capture 90 experiences of discharge communication. Participating GPs initially screened and selected a range of recent discharge letters which they assessed to be successful and unsuccessful exemplars. These letters identified potential participants who were invited to take part: the HP letter writer, GP recipient and patient. Participant viewpoints are collected through interviews, focus groups and surveys and will be "matched" to the discharge letter sample, so forming multiple-perspective "quartet" cases. These "quartets" allow direct comparisons between different discharge experiences within the same communicative event. The methods for analysis draw on techniques from the fields of Applied Linguistics and Health Sciences, including: corpus linguistics; inferential statistics; content analysis. DISCUSSION This mixed-methods study is novel in attempting to triangulate views of patients, GPs and HPs in relation to specific discharge letters. Patient and practitioner involvement will inform design decisions and interpretation of findings. Recommendations for improving discharge letters and the process of patients receiving letters will be made, with the intention of informing guidelines on discharge communication. Ethics approval was granted in July 2017 by the UK Health Research Authority. Findings will be disseminated in peer-reviewed journals, reports and newsletters, and presentations.
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Affiliation(s)
- Katharine Weetman
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Emma Scott
- Unit of Academic Primary Care, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Stephanie Schnurr
- Centre for Applied Linguistics, University of Warwick, Coventry, CV4 7AL UK
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Redmond P, McDowell R, Grimes TC, Boland F, McDonnell R, Hughes C, Fahey T. Unintended discontinuation of medication following hospitalisation: a retrospective cohort study. BMJ Open 2019; 9:e024747. [PMID: 31167862 PMCID: PMC6561421 DOI: 10.1136/bmjopen-2018-024747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/01/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Whether unintended discontinuation of common, evidence-based, long-term medication occurs after hospitalisation; what factors are associated with unintended discontinuation; and whether the presence of documentation of medication at hospital discharge is associated with continuity of medication in general practice. DESIGN Retrospective cohort study between 2012 and 2015. SETTING Electronic records and hospital supplied discharge notifications in 44 Irish general practices. PARTICIPANTS 20 488 patients aged 65 years or more prescribed long-term medication for chronic conditions. PRIMARY AND SECONDARY OUTCOMES Discontinuity of four evidence-based medication drug classes: antithrombotic, lipid-lowering, thyroid replacement drugs and respiratory inhalers in hospitalised versus non-hospitalised patients; patient and health system factors associated with discontinuity; impact of the presence of medication in the hospital discharge summary on continuity of medication in a patient's general practitioner (GP) prescribing record at 6 months follow-up. RESULTS In patients admitted to hospital, medication discontinuity ranged from 6%-11% in the 6 months posthospitalisation. Discontinuity of medication is significantly lower for hospitalised patients taking respiratory inhalers (adjusted OR (AOR) 0.63, 95% CI (0.49 to 0.80), p<0.001) and thyroid medications (AOR 0.62, 95% CI (0.40 to 0.96), p=0.03). There is no association between discontinuity of medication and hospitalisation for antithrombotics (AOR 0.95, 95% CI (0.81 to 1.11), p=0.49) or lipid lowering medications (AOR 0.92, 95% CI (0.78 to 1.08), p=0.29). Older patients and those who paid to see their GP were more likely to experience increased odds of discontinuity in all four medicine groups. Less than half (39% to 47.4%) of patients had medication listed on their hospital discharge summary. Presence of medication on hospital discharge summary is significantly associated with continuity of medication in the GP prescribing record for lipid lowering medications (AOR 1.64, 95% CI (1.15 to 2.36), p=0.01) and respiratory inhalers (AOR 2.97, 95% CI (1.68 to 5.25), p<0.01). CONCLUSION Discontinuity of evidence-based long-term medication is common. Increasing age and private medical care are independently associated with a higher risk of medication discontinuity. Hospitalisation is not associated with discontinuity but less than half of hospitalised patients have medication recorded on their hospital discharge summary.
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Affiliation(s)
- Patrick Redmond
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- School of Population Health and Environmental Sciences, King’s College London, London, UK
| | - Ronald McDowell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Public Health, Queen’s University, Cancer Epidemiology and Health Services Group, Belfast, UK
| | | | - Fiona Boland
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ronan McDonnell
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queens University Belfast, Belfast, UK
| | - Tom Fahey
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Wuyts J, Vande Ginste M, De Lepeleire J, Foulon V. Discharge report for the community pharmacist: Development and validation of a prototype. Res Social Adm Pharm 2019; 16:168-177. [PMID: 31078447 DOI: 10.1016/j.sapharm.2019.04.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/10/2019] [Accepted: 04/19/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND The potential benefit of community pharmacist's involvement in continuity of care is well-known. However, it is not standard practice to exchange information with the community pharmacist (CP) after hospitalization. OBJECTIVE To construct and validate an evidence-based prototype of a discharge report for the community pharmacist. METHODS First, a review of literature, guidelines and established initiatives was performed to construct a preliminary discharge report. Secondly, the content of the discharge report was reviewed and optimized using semi-structured individual interviews with CPs and general practitioners (GPs). RESULTS The review identified six guidelines for information exchange with the CP originating from three countries, 17 research papers and three local initiatives. Overall, 49 different elements for a discharge document were identified. Based on recurring elements, a preliminary discharge report was created. Interviews with ten CPs and nine GPs provided insights into which information is considered crucial for patient safety and why. This allowed an optimization of the document. The final discharge report consists of three categories: administrative, medication and medical data. The medication data includes medication registered at hospital admission as well as at hospital discharge, drug indications, reasons for initiating, adjusting or discontinuing therapies and start/stop dates. The medical data contains reasons for hospitalization, comorbidities and allergies. CONCLUSIONS The literature review and semi-structured interviews resulted in an evidence-based prototype of a discharge report for the community pharmacist. This document contains both administrative, medical and medication data.
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Affiliation(s)
- Joke Wuyts
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium.
| | - Marie Vande Ginste
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium.
| | - Jan De Lepeleire
- KU Leuven, Department Public Health and Primary Care, 3000, Leuven, Belgium.
| | - Veerle Foulon
- KU Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000, Leuven, Belgium.
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20
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Accuracy of pharmacist electronic discharge medicines review information transmitted to primary care at discharge. Int J Clin Pharm 2019; 41:820-824. [PMID: 31028594 DOI: 10.1007/s11096-019-00835-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
Background The poor quality of discharge summaries following admission to hospital, especially in relation to information on medication changes, is well documented. Hospital pharmacists can record changes to medications in the electronic discharge note to improve the quality of this information for primary care. Objective To audit the pharmacist-completed notes describing changes to admission medication, and to identify improvement opportunities. Setting 750-bed teaching district general hospital in England. Methods An evaluation of pharmacist written notes was conducted at a 750-bed teaching district general hospital in England. A sample of notes was analysed in three consecutive years, 2016-2018. Analyses were performed using descriptive statistics. Main outcome measure The number of discrepancies in the note compared to the discharge summary medication list. Results Notes were analysed for 125, 120 and 120 patients in 2016-2018 respectively. We saw an overall improvement in the accuracy of our notes from 12% of patients having an inaccurate note in 2016 to 4.2% in 2017 and 5.8% in 2018. The percentage of discharge medicines affected by these discrepancies reduced from 1.7% (2016) to 0.6% (2017) and 0.9% (2018). Conclusion Discrepancies were due to changes in the patient's medicines journey not being fully captured and documented. The overall reduction of discrepancies over the three consecutive audits was felt to be largely due to formalisation of the discharge medicines reconciliation process and reminding staff on how to complete a note. We are planning to utilise informatics surveillance tools along with system developments to sustain this elimination of out of date notes being transmitted to primary care.
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Cheng DR, Katz ML, South M. Integrated Electronic Discharge Summaries-Experience of a Tertiary Pediatric Institution. Appl Clin Inform 2018; 9:734-742. [PMID: 30231259 DOI: 10.1055/s-0038-1669461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Succinct and timely discharge summaries (DSs) facilitate ongoing care for patients discharged from acute care settings. Many institutions have introduced electronic DS (eDS) templates to improve quality and timeliness of clinical correspondence. However, significant intrahospital and intraunit variability and application exists. A review of the literature and guidelines revealed 13 key elements that should be included in a best practice DS. This was compared against our pediatric institution's eDS template-housed within an integrated electronic medical record (EMR) and used across most inpatient hospital units. METHODS Uptake and adherence to the suggested key elements was measured by comparing all DSs for long stay inpatients (> 21-day admission) during the first year of the EMR eDS template's usage (May 2016-April 2017). RESULTS A total of 472 DSs were evaluated. Six of 13 key elements were completed in > 98.0% of DSs. Conversely, only < 5.0% included allergies or adverse reaction data, and < 11.0% included ceased medications or pending laboratory results. Inclusion of procedure information and pending laboratory results significantly improved with time (p = 0.05 and p < 0.04, respectively), likely as doctors became more familiar with EMR and autopopulation functions. Inclusion of "discharge diagnosis" differed significantly between medical (n = 406/472; 99.0%) and surgical (n = 32/472; 51.6%) DSs. CONCLUSION Uptake and adherence to an EMR eDS template designed to meet best practice guidelines in a pediatric institution was strong, although significant improvements in specific data elements are needed. Strategies can include a modification of existing eDS templates and junior medical staff education around best practice.
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Affiliation(s)
- Daryl R Cheng
- EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Merav L Katz
- EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Mike South
- EMR Project Team, The Royal Children's Hospital Melbourne, Parkville, Australia.,Department of General Medicine, The Royal Children's Hospital Melbourne, Parkville, Australia
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O'Connor R, O'Callaghan C, McNamara R, Salim U. An audit of discharge summaries from secondary to primary care. Ir J Med Sci 2018; 188:537-540. [PMID: 30019095 DOI: 10.1007/s11845-018-1862-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/05/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Health is information-intensive. Reliable health care depends on access to this information in a timely and accurate manner. A standardised data set for clinical discharge summaries is essential to optimise the care the patient receives, particularly at discharge. The Irish Health Information and Quality Authority (HIQA) have recently developed a national standard for patient discharge summaries. AIMS Our aim was to assess the current quality of discharge summaries being received, determine the main areas of concern and establish the areas to improve patient safety. METHODS We studied 60 discharge summaries received at 3 general practices in the Mid-West of Ireland. We used HIQA "National Standard for Patient Discharge Summary" 2013 as our audit standard. RESULTS Mandatory fields including Surname, Forename and date of birth were present in 100%, missing in 0%. The patient's address was missing in 7% (n = 4). Gender was missing in 82% (n = 50). Source of referral was missing in 52% (n = 32). No method of admission was documented in 70% (n = 43). Whilst principal diagnosis was documented in 100% (n = 60), no co-morbidities were documented in 28% (n = 17). No medication was documented in 30% (n = 18), and there was no documentation of medication changed in 39% (n = 24). Details of the person completing the discharge summary were incomplete as follows: 85% (n = 52) had no specialty documentation, 36% (n = 22) had no registration number and 38% (n = 23) had no contact number. CONCLUSIONS This audit shows deficits in adhering to HIQA standards. These must be addressed as a matter of urgency.
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Affiliation(s)
- Ray O'Connor
- Department of General Practice, Graduate Entry Medical School, University of Limerick, Limerick, Ireland. .,Mid-Western Specialist Training Programme in General Practice, Room GEMS 1-019, University of Limerick, Limerick, Ireland.
| | - Cliodhna O'Callaghan
- Mid-Western Specialist Training Programme in General Practice, Room GEMS 1-019, University of Limerick, Limerick, Ireland
| | - Roisin McNamara
- Mid-Western Specialist Training Programme in General Practice, Room GEMS 1-019, University of Limerick, Limerick, Ireland
| | - Umbreen Salim
- Mid-Western Specialist Training Programme in General Practice, Room GEMS 1-019, University of Limerick, Limerick, Ireland
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23
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Tan Y, Elliott RA, Richardson B, Tanner FE, Dorevitch MI. An audit of the accuracy of medication information in electronic medical discharge summaries linked to an electronic prescribing system. Health Inf Manag 2018; 47:125-131. [PMID: 29587532 DOI: 10.1177/1833358318765192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Poor communication of medication information to general practitioners when patients are discharged from hospital is a widely recognised problem. There has been little research exploring the accuracy of medication information in electronic discharge summaries (EDS) linked to hospital e-prescribing systems. OBJECTIVE To evaluate the accuracy of medication lists and medication change information in EDS produced using an integrated e-prescribing and EDS system (where EDS discharge medication lists were imported from discharge e-prescription records, medication change information was manually entered, and medications were dispensed from paper copies of the patients' e-prescriptions). METHOD Retrospective audit of EDSs for a random sample, representative of adult patients ( n = 87) discharged from a major teaching hospital. EDS medication lists were compared to pharmacist-verified paper discharge prescriptions (considered to be the most accurate discharge medication list) to identify discrepancies. EDS medication change information was compared to medication changes identified by comparing pharmacist-verified "Medication History on Admission" forms with pharmacist-verified paper discharge prescriptions. RESULTS There were 85/87 (98%) EDSs that included a discharge medication list. Of these, 50/85 (59%) contained one or more medication list discrepancies (median 1, range 0-15). The most common discrepancy was omission of medication (58%); 84/131 (64%) discrepancies were considered clinically significant (risk of adverse outcome); 162/351 (46%) clinically significant medication changes were stated in the EDS; and 153/351 (44%) changes were both stated and included a reason. CONCLUSION EDS discrepancies were common despite integration with e-prescribing. Eliminating paper prescriptions, enhancing e-prescribing/EDS functionality and involving pharmacists in EDS preparation may reduce discrepancies.
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Mills PR, Weidmann AE, Stewart D. Hospital staff views of prescribing and discharge communication before and after electronic prescribing system implementation. Int J Clin Pharm 2017; 39:1320-1330. [PMID: 29076013 PMCID: PMC5694510 DOI: 10.1007/s11096-017-0543-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022]
Abstract
Background Electronic prescribing system implementation is recommended to improve patient safety and general practitioner's discharge information communication. There is a paucity of information about hospital staff perspectives before and after system implementation. Objective To explore hospital staff views regarding prescribing and discharge communication systems before and after hospital electronic prescribing and medicines administration (HEPMA) system implementation. Setting A 560 bed United Kingdom district general hospital. Methods Semi-structured face-to-face qualitative interviews with a purposive sample of hospital staff involved in the prescribing and discharge communication process. Interviews transcribed verbatim and coded using the Framework Approach. Behavioural aspects mapped to Theoretical Domains Framework (TDF) to highlight associated behavioural change determinants. Main outcome measure Staff perceptions before and after implementation. Results Nineteen hospital staff (consultant doctors, junior doctors, pharmacists and advanced nurse practitioners) participated before and after implementation. Pre-implementation main themes were inpatient chart and discharge letter design and discharge communication process with issues of illegible and inaccurate information. Improved safety was anticipated after implementation. Post-implementation themes were improved inpatient chart clarity and discharge letter quality. TDF domains relevant to staff behavioural determinants preimplementation were knowledge (task or environment); skills (competence); social/professional roles and identity; beliefs about capabilities; environmental context and resources (including incidents). An additional two were relevant post-implementation: social influences and behavioural regulation (including self-monitoring). Participants described challenges and patient safety concerns pre-implementation which were mostly resolved post-implementation. Conclusion HEPMA implementation produced perceptions of patient safety improvement. TDF use enabled behaviour change analysis due to implementation, for example, staff adoption of behaviours to ensure general practitioners receive good quality discharge information.
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Affiliation(s)
- Pamela Ruth Mills
- Pharmacy Department, University Hospital Crosshouse, Kilmarnock, Ayrshire, Scotland, KA2 0BE, UK.
| | - Anita Elaine Weidmann
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, AB10 7GJ, UK
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, Scotland, AB10 7GJ, UK
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Uitvlugt EB, Suijker R, Janssen MJA, Siegert CEH, Karapinar-Çarkit F. Quality of medication related information in discharge letters: A prospective cohort study. Eur J Intern Med 2017; 46:e23-e25. [PMID: 28986157 DOI: 10.1016/j.ejim.2017.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Elien B Uitvlugt
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Regina Suijker
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Marjo J A Janssen
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Carl E H Siegert
- OLVG, Department of Internal Medicine, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
| | - Fatma Karapinar-Çarkit
- OLVG, Department of Clinical Pharmacy, Jan Tooropstraat 164, 1061AE Amsterdam, The Netherlands.
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Garcia BH, Djønne BS, Skjold F, Mellingen EM, Aag TI. Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records. Int J Clin Pharm 2017; 39:1331-1337. [PMID: 29101617 DOI: 10.1007/s11096-017-0556-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022]
Abstract
Background Low quality of medication information in discharge summaries from hospitals may jeopardize optimal therapy and put the patient at risk for medication errors and adverse drug events. Objective To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Setting Helgelandssykehuset Mo i Rana, a rural hospital in central Norway. Method For each month in 2013, we randomly selected 60 discharge summaries from the Department of Medicine and Surgery (totally 720) and evaluated the medication information using eight Norwegian quality criteria. Main outcome measure Mean score per discharge summary ranging from 0 (lowest quality) to 16 (highest quality). Results Mean score per discharge summary was 7.4 (SD 2.8; range 0-14), significantly higher when evaluating medications used regularly compared to mediations used as needed (7.80 vs. 6.52; p < 0.001). Lowest score was achieved for quality criteria concerning generic names, indications for medication use, reasons why changes had been made and information about the source for information. Factors associated with increased quality scores are increasing numbers of medications and male patients. Increasing age seemed to be associated with a reduced score, while type of department was not associated with the quality. Conclusion In discharge summaries from 2013, we identified a low quality of medication information in accordance with the Norwegian quality criteria. Actions for improvement are necessary and follow-up studies to monitor quality are needed.
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Affiliation(s)
- Beate Hennie Garcia
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, 9037, Tromsø, Norway. .,Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF), Postboks 6147, Langnes, 9291, Tromsø, Norway.
| | - Berit Svendsen Djønne
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, 9037, Tromsø, Norway
| | - Frode Skjold
- Department of Pharmacy, Faculty of Health Sciences, UiT the Arctic University of Norway, 9037, Tromsø, Norway
| | - Ellen Marie Mellingen
- Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF), Postboks 6147, Langnes, 9291, Tromsø, Norway.,Helgelandssykehuset Mo i Rana, Sjøforsgata 36, 8613, Mo i Rana, Norway
| | - Trine Iversen Aag
- Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF), Postboks 6147, Langnes, 9291, Tromsø, Norway.,Helgelandssykehuset Mo i Rana, Sjøforsgata 36, 8613, Mo i Rana, Norway
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Mills PR, Weidmann AE, Stewart D. Hospital electronic prescribing system implementation impact on discharge information communication and prescribing errors: a before and after study. Eur J Clin Pharmacol 2017; 73:1279-1286. [PMID: 28643030 PMCID: PMC5599458 DOI: 10.1007/s00228-017-2274-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/25/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE The study aimed to test the hypothesis that hospital electronic prescribing and medicine administration system (HEPMA) implementation impacted patient discharge letter quality, nature and frequency of prescribing errors. METHOD A quasi experimental before and after retrospective case note review was conducted in one United Kingdom district general hospital. The total sample size was 318 (random samples of 159 before and after implementation), calculated to achieve a 10% error reduction with a power of 80% and p < 0.05. Adult patients discharged after ≥24-h inpatient stay were assessed for discharge information documentation quality using a modified validated discharge document template. Prescribing errors were classified as medicine omissions, commissions, incorrect dose/frequency/duration, drug interactions, therapeutic duplications or missing/inaccurate allergy information. Post-implementation assessments were undertaken 4 months following HEPMA implementation. Error severity was determined by a multidisciplinary panel consensus using the Medications at Transitions and Clinical Handoffs (MATCH) study validated scoring system. RESULTS There were no statistically significant differences in patient demographics between the pre- and post-implementation groups. Discharge information documentation quality improved; allergy documentation increased from 11 to 159/159 (p < 0.0001). The number of patients with prescribing errors reduced significantly from 158 to 37/159 (p < 0.001). Prescribing error category incidence identified in pre-implementation patients was reduced (e.g. omission incidence from 66 to 18/159 (p < 0.001)), although a new error type (sociotechnical [errors caused by the system]) was identified post-implementation (n = 8 patients). Post-implementation prescribing errors severity rating identified 8/37 as likely to cause potential patient harm. CONCLUSION HEPMA implementation was associated with improved discharge documentation quality, statistically significant prescribing error reduction and prescribing error type alteration. There remains a need to be alert for potential prescribing errors.
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Affiliation(s)
- Pamela Ruth Mills
- University Hospital Crosshouse, Pharmacy Department, Kilmarnock, Ayrshire, KA2 OBE, Scotland, UK.
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, Scotland, UK.
| | - Anita Elaine Weidmann
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, Scotland, UK
| | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, AB10 7GJ, Scotland, UK
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28
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Bain A, Nettleship L, Kavanagh S, Babar ZUD. Evaluating insulin information provided on discharge summaries in a secondary care hospital in the United Kingdom. J Pharm Policy Pract 2017; 10:25. [PMID: 28852529 PMCID: PMC5567465 DOI: 10.1186/s40545-017-0113-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/14/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Prescribing errors at the time of hospital discharge are common and could potentially lead to avoidable patient harm, especially when they involve insulin, a high-risk medicine widely used for the treatment of diabetes mellitus. When information regarding insulin therapy is not sufficiently communicated to a patient's primary care provider, continuity of care for patients with diabetes may be compromised. The objectives of this study were to investigate the nature and prevalence of insulin-related medication discrepancies contained in hospital discharge summaries for patients with diabetes. A further objective was to examine the timeliness and completeness of relevant information regarding insulin therapy provided on discharge summaries. METHODS The study was undertaken at a large foundation trust hospital in the North of England, UK. A retrospective analysis of discharge summaries of all patients who were being treated with insulin and were included in the 2016 National Inpatient Diabetes Audit was conducted. Insulin regimen information provided on discharge summaries was scrutinised in light of available medical records pertaining to the admission and current national recommendations. RESULTS Thirty-three (79%) out of the 42 patients included in the study had changes made to their insulin regimen during hospital admission. Eighteen (43%) patients were identified as having an error or discrepancy relating to insulin on their discharge summary. A total of 27 insulin errors or discrepancies were identified on discharge, most commonly involving non-communication of an insulin dose change (n = 8) and wrong insulin device (n = 7). Seventeen issues relating to completeness of insulin information were identified, including the omission of the prescribed time of insulin administration (n = 10) and unexplained insulin dose change (n = 4). Two patients who had insulin-related errors identified on their discharge summaries were readmitted to hospital within 30 days of discharge due to poor diabetic control. CONCLUSIONS This small-scale study demonstrates that errors and discrepancies regarding insulin therapy on discharge persist despite current insulin safety initiatives. Poorly communicated information regarding insulin therapy may jeopardise optimal glycaemic control and continuity of patient care. Insulin-related information should be comprehensively documented at the point of discharge. This is to improve communication across the interface and to minimise risks to patient safety.
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Affiliation(s)
- Amie Bain
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH United Kingdom
| | - Lois Nettleship
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH United Kingdom
| | - Sallianne Kavanagh
- Pharmacy Department, Sheffield Teaching Hospital NHS Foundation Trust, Herries Road, Sheffield, S5 7AU United Kingdom
| | - Zaheer-Ud-Din Babar
- School of Applied Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH United Kingdom
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Private Mail Bag, Auckland, 92019 New Zealand
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Using the Behaviour Change Wheel to identify interventions to facilitate the transfer of information on medication changes on electronic discharge summaries. Res Social Adm Pharm 2017; 13:456-475. [DOI: 10.1016/j.sapharm.2016.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/15/2022]
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30
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Aziz C, Grimes T, Deasy E, Roche C. Compliance with the Health Information and Quality Authority of Ireland National Standard for Patient Discharge Summary Information: a retrospective study in secondary care. Eur J Hosp Pharm 2016; 23:272-277. [PMID: 31156864 PMCID: PMC6451507 DOI: 10.1136/ejhpharm-2015-000748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 01/01/2016] [Accepted: 01/13/2016] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Unexplained changes to medication are common at hospital discharge and underscore the need to standardise patient discharge clinical documentation. In 2013, the Health Information and Quality Authority in Ireland published a Standard on the structure and content of discharge summaries. The intention was to ensure that all necessary information was complete and communicated to the next care provider. OBJECTIVES This study investigated one Hospital's compliance with the Standard, and appraised two methods of electronic discharge communication (Symphony or Tallaght Education and Audit Management System (TEAMS)). METHOD A retrospective survey of 198 randomly selected discharge summaries was conducted at the study hospital, a 600 bed academic teaching hospital located in Dublin, Ireland. RESULTS Of the 198 evaluated summaries, mean total compliance was 77%±4.2 (95% CI 76.3 to 77.5). Most (84.7%, n=173) summaries were completed using one of the systems (TEAMS). Absence of communication about alteration of preadmission medication was frequent (107 out of 130 patients (82.3%, CI 76.2 to 89.2)). Higher compliance rates were observed however, when information was interfaced or where there were dedicated fields to be completed. CONCLUSIONS Efforts to improve compliance with the National Standard for Patient Discharge Summary Information should focus on reporting changes made to medication during hospitalisation.
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Affiliation(s)
- Claudine Aziz
- Department of Pharmacy, Trinity College Dublin, Dublin, Ireland
| | - Tamasine Grimes
- Department of Pharmacy, Trinity College Dublin, Dublin, Ireland
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Evelyn Deasy
- Pharmacy Department, Tallaght Hospital, Dublin, Ireland
| | - Cicely Roche
- Department of Pharmacy, Trinity College Dublin, Dublin, Ireland
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Keers RN, Williams SD, Vattakatuchery JJ, Brown P, Miller J, Prescott L, Ashcroft DM. Medication safety at the interface: evaluating risks associated with discharge prescriptions from mental health hospitals. J Clin Pharm Ther 2015; 40:645-54. [DOI: 10.1111/jcpt.12328] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/20/2015] [Indexed: 12/17/2022]
Affiliation(s)
- R. N. Keers
- Centre for Pharmacoepidemiology and Drug Safety; Manchester Pharmacy School; Manchester Academic Health Sciences Centre (MAHSC); University of Manchester; Manchester UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre; MAHSC; University of Manchester; Manchester UK
| | - S. D. Williams
- Centre for Pharmacoepidemiology and Drug Safety; Manchester Pharmacy School; Manchester Academic Health Sciences Centre (MAHSC); University of Manchester; Manchester UK
- Pharmacy Department; University Hospital of South Manchester NHS Foundation Trust; MAHSC; Manchester UK
| | - J. J. Vattakatuchery
- Adult Services Warrington; 5 Boroughs Partnership NHS Foundation Trust; Warrington Cheshire UK
- Medical School; University of Liverpool; Liverpool UK
| | - P. Brown
- Pharmacy Department; Manchester Mental Health and Social Care Trust; MAHSC; Manchester UK
| | - J. Miller
- Pharmacy Department; Greater Manchester West Mental Health NHS Foundation Trust; Salford UK
| | - L. Prescott
- Medicines Management Team; 5 Boroughs Partnership NHS Foundation Trust; Warrington Cheshire UK
| | - D. M. Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety; Manchester Pharmacy School; Manchester Academic Health Sciences Centre (MAHSC); University of Manchester; Manchester UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre; MAHSC; University of Manchester; Manchester UK
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From Inpatient Notes to Outpatient Followup: Enhancing the Rhinology Service in a Tertiary Centre through Student Led Projects. Int J Otolaryngol 2015; 2015:197823. [PMID: 26345579 PMCID: PMC4544879 DOI: 10.1155/2015/197823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 07/30/2015] [Indexed: 11/18/2022] Open
Abstract
Introduction. Medical students can use systems to help improve the quality of care in a unit. Following the review of care within the ENT department at a tertiary centre a number of quality improvement projects were put in place. Methods. The following interventions were established: (1) creation of an outpatient telephone enquiry clinic, (2) development of a rhinology database, (3) introduction of operative note templates, and (4) construction of electronic discharge summary templates (eDSTs). Discussion and Outcomes. (1) Consultant telephone inquiry clinics were successfully organised and showed high levels of patient satisfaction. (2) A database to collect patient reported outcome measures was piloted within rhinology outpatients; the results suggest that such a database would be simple to introduce and yield benefits for patients and the department. (3) Operative note templates for FESS procedures were implemented with a view to improving the continuity of care onto the ward; these have become well established and further steps to integrate these into routine care are being taken. (4) eDSTs specific to FESS and septorhinoplasty procedures were introduced with a view to increasing completion speed of templates and adherence to Royal College of Physician Guidance.
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Mills PR, Weidmann AE, Stewart D. Hospital discharge information communication and prescribing errors: a narrative literature overview. Eur J Hosp Pharm 2015; 23:3-10. [PMID: 31156807 DOI: 10.1136/ejhpharm-2015-000677] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/03/2022] Open
Abstract
Objectives To provide a narrative overview of the literature on discharge information communication and medicines discharge prescribing error rate in the UK and other similar healthcare systems. Methods A narrative review of the peer reviewed literature (2000-2014) on communication of discharge information from hospitals to general practitioners. Databases included were MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index and Abstracts, and International Pharmacy Abstracts database. Results The search yielded 673 results with 15 papers satisfying all inclusion criteria. Direct comparison of studies was not feasible due to differences in study populations and outcome measures. No studies reported post Hospital Electronic Prescribing and Medicine Administration (HEPMA) implementation. Studies (n=6) investigating handwritten discharge communication systems demonstrated medicine information inaccuracy ranging from 0.81 errors per patient to 17.5% medicines with errors and 67% letters missing medicines change information; with 77% assessed as legible. Studies (n=4) comparing interim electronic solutions with traditional showed variable results: improved, unchanged or decreased medicine information accuracy. Studies researching solely interim electronic solutions (n=5) with one including prescribing error rate assessment at 8.4% of prescribed items and identification of a new electronic system-related error type. Conclusion Implementation of interim electronic discharge solutions resulted in complete legibility but did not eradicate information and prescribing errors. A paucity of information is available about HEPMA implementation impact on discharge information communication and prescribing error rates. There is urgent need for formal evaluation in this area.
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Affiliation(s)
| | | | - Derek Stewart
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK
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