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Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [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: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Alcântara TDS, Carvalho GAC, Sanchez JM, Ramos SF, Cunha LC, Araújo-Neto FDC, Valença-Feitosa F, Silvestre CC, Lyra Junior DPD. Quality indicators of hospitalized children influenced by clinical pharmacist services: A systematic review. Res Social Adm Pharm 2023; 19:1315-1330. [PMID: 37442709 DOI: 10.1016/j.sapharm.2023.07.003] [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: 10/28/2022] [Revised: 05/31/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Care for children who are hospitalized can be optimized if the pharmacist, in conjunction with the multidisciplinary team, promotes the rational use of medicines. In this sense, the evaluation of the quality of these clinical services through indicators is important in the planning, decision making of pharmacists and managers of these services. OBJECTIVE To characterize which health indicators were influenced by the pharmaceutical clinical services for the care of children in hospitals. METHODS A systematic review was performed. The search for data was made on the bases: Cochrane, Embase, Lilacs, Pubmed and Web of Science. Then, the search included studies in which evaluated the impact of pharmaceutical clinical services on clinical, economic and humanistic outcomes. RESULTS The search resulted in 11 included studies. In this review, four pharmaceutical clinical services were found: pharmacotherapy review, multiprofessional team interventions, antimicrobial stewardship program and pharmaceutical services at discharge hospital. The most influenced outcome indicators were length of hospital stay, with average time in the group that received the pharmacotherapy review service, and interventions multiprofessional team with a 6.45-day vs. 10.83 days in the control group; hospital readmissions with a significant reduction of non-scheduled readmission of 30 days in the ntimicrobial stewardship program; reduction of hospital costs and caregiver satisfaction. CONCLUSION In this study, we can highlight that pharmacotherapy review, multiprofessional team interventions and Antimicrobial Stewardship Program that significantly reduced the clinical results of length of hospital stay and hospital readmission, as well as a significant reduction of hospital costs.
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Affiliation(s)
- Thaciana Dos Santos Alcântara
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | | | - Júlia Mirão Sanchez
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil
| | - Sheila Feitosa Ramos
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Luiza Correia Cunha
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernando de Castro Araújo-Neto
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Fernanda Valença-Feitosa
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
| | - Carina Carvalho Silvestre
- Department of Pharmacy, Life Sciences Institute, Federal University of Juiz de Fora, Campus Governador Valadares, Brazil.
| | - Divaldo Pereira de Lyra Junior
- Laboratory of Teaching and Research in Social Pharmacy (LEPFS), Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
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Kurpas D, Mendive JM, Vidal-Alaball J, Petrazzuoli F, Morad M, Kloppe T, Herrman W, Mrduljaš-Đujić N, Kenkre J. European Perspective on How Social Prescribing Can Facilitate Health and Social Integrated Care in the Community. Int J Integr Care 2023; 23:13. [PMID: 37151777 PMCID: PMC10162193 DOI: 10.5334/ijic.7636] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 04/21/2023] [Indexed: 05/09/2023] Open
Abstract
Social Prescribing is a mechanism by which primary care team members can refer patients to community groups to improve their health and well-being. It integrates health, social care, and community, allowing patients to actively improve their health and well-being by participating in community initiatives and activities. These activities have traditionally been part of community life in European countries, and the benefits need to be consistently recognized.
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Affiliation(s)
- Donata Kurpas
- Health Sciences Faculty, Wroclaw Medical University, Poland
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Poland
- European Rural and Isolated Practitioner Association (EURIPA), Poland
| | - Juan Manuel Mendive
- European Rural Isolated Practitioner Association, WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Spain
- Institut Català de la Salut, Universitat Autònoma de Barcelona, Spain
| | - Josep Vidal-Alaball
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Spain
- European Rural and Isolated Practitioner Association (EURIPA), Spain
- Institut Català de la Salut and University of Vic, Cataluña, Spain
| | - Ferdinando Petrazzuoli
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Sweden
- European Rural and Isolated Practitioner Association (EURIPA), Sweden
- Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Mohammed Morad
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Israel
- European Rural and Isolated Practitioner Association (EURIPA), Israel
- Department of family medicine, Community Health Division, Faculty of Health Sciences, Ben Gurion University of the Negev, Israel
| | - Thomas Kloppe
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Germany
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Germany
| | - Wolfram Herrman
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Germany
- Institute of General Practice and Family Medicine, Charité – Universitätsmedizin Berlin, Germany
| | - Nataša Mrduljaš-Đujić
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, Croatia
- European Rural and Isolated Practitioner Association (EURIPA), Croatia
- Department of Family Medicine, University of Split, School of Medicine, Croatia
| | - Joyce Kenkre
- WONCA Europe Social Prescribing and Community Orientation Special Interest Group, UK
- European Rural and Isolated Practitioner Association (EURIPA), UK
- University of South Wales, UK
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Alves da Costa F, Rydant S, Antoniou S. The patient pathway in cardiovascular care: A position paper from the International Pharmacists for Anticoagulation Care Taskforce (iPACT). J Eval Clin Pract 2020; 26:670-681. [PMID: 31994273 DOI: 10.1111/jep.13316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 07/17/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND This position paper highlights the opportunistic integral role of the pharmacist across the patient pathway utilizing cardiovascular care as an example. The paper aims to highlight the potential roles that pharmacists worldwide can have (or already have) to provide efficient patient care in the context of interprofessional collaboration. METHODS It results from a literature review and experts seeking advice to identify existing interventions and potential innovative interventions. We developed a conceptual framework highlighting seven critical phases in the patient pathway and for each of those listed some of the initiatives identified by our experts worldwide. RESULTS Existing pharmacists' interventions in each of these phases have been identified globally. Various examples in the area of prevention and self-management were found to exist for long; the contribution for early detection and subsequently to timely diagnosis were also quite clear; integration of care was perhaps one of the areas needing greater development, although interventions in secondary care were also quite common. Tertiary care and end of life interventions were found to often be left for other healthcare professionals. CONCLUSION On the basis of the findings, we can argue that much has been done but globally consider that pharmacists are still an untapped resource potentially useful for improved patient care.
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Affiliation(s)
- Filipa Alves da Costa
- Centre for Interdisciplinary Research Egas Moniz (CiiEM), University Institute Egas Moniz, Campus Universitário, Caparica, Portugal.,Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Silas Rydant
- Meduca, Royal Pharmacist Association of Antwerp (KAVA), Antwerp, Belgium
| | - Sotiris Antoniou
- Department of Pharmacy, Barts Health NHS Trust, UCL Partners, London, UK
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5
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Mantzourani E, Nazar H, Phibben C, Pang J, John G, Evans A, Thomas H, Way C, Hodson K. Exploring the association of the discharge medicines review with patient hospital readmissions through national routine data linkage in Wales: a retrospective cohort study. BMJ Open 2020; 10:e033551. [PMID: 32041857 PMCID: PMC7045023 DOI: 10.1136/bmjopen-2019-033551] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To evaluate the association of the discharge medicines review (DMR) community pharmacy service with hospital readmissions through linking National Health Service data sets. DESIGN Retrospective cohort study. SETTING All hospitals and 703 community pharmacies across Wales. PARTICIPANTS Inpatients meeting the referral criteria for a community pharmacy DMR. INTERVENTIONS Information related to the patient's medication and hospital stay is provided to the community pharmacists on discharge from hospital, who undertake a two-part service involving medicines reconciliation and a medicine use review. To investigate the association of this DMR service with hospital readmission, a data linking process was undertaken across six national databases. PRIMARY OUTCOME Rate of hospital readmission within 90 days for patients with and without a DMR part 1 started. SECONDARY OUTCOME Strength of association of age decile, sex, deprivation decile, diagnostic grouping and DMR type (started or not started) with reduction in readmission within 90 days. RESULTS 1923 patients were referred for a DMR over a 13-month period (February 2017-April 2018). Provision of DMR was found to be the most significant attributing factor to reducing likelihood of 90-day readmission using χ2 testing and classification methods. Cox regression survival analysis demonstrated that those receiving the intervention had a lower hospital readmission rate at 40 days (p<0.000, HR: 0.59739, CI 0.5043 to 0.7076). CONCLUSIONS DMR after a hospital discharge is associated with a reduction in risk of hospital readmission within 40 days. Linking data across disparate national data records is feasible but requires a complex processual architecture. There is a significant value for integrated informatics to improve continuity and coherency of care, and also to facilitate service optimisation, evaluation and evidenced-based practice.
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Affiliation(s)
- Efi Mantzourani
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Hamde Nazar
- School of Pharmacy, The Faculty of Medical Services, Newcastle University, UK
| | | | | | - Gareth John
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | | | - Helen Thomas
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Cheryl Way
- NHS Wales Informatics Service, Cardiff, Wales, UK
| | - Karen Hodson
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK
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Liang C, Zhou S, Yao B, Hood D, Gong Y. Toward systems-centered analysis of patient safety events: Improving root cause analysis by optimized incident classification and information presentation. Int J Med Inform 2019; 135:104054. [PMID: 31864129 DOI: 10.1016/j.ijmedinf.2019.104054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/18/2019] [Accepted: 12/11/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND Systems-centered root cause analysis (RCA) of patient safety events presents unique advantages as it aims to disclose vulnerabilities of healthcare systems. However, the increasing number of collected events poses the problems of low efficiency and information overload for traditional RCA. OBJECTIVES This study aims to improve systems-centered RCA by developing optimized information extraction and presentation. METHODS We experimented supervised machine-learning methods to extract safety-related information from 3333 de-identified patient safety event reports from two independent sources. Based on the extracted information, we further evaluated how optimized information presentation could help facilitate the disclosure of system vulnerabilities in traditional RCA. RESULTS Multilabel text classification is effective in identifying safety-related information from the narrative description of patient safety events. The Pruned Sets in conjunction with Naïve Bayes are the outperformed algorithm in one dataset, with an overall F score of 60.0 % and the highest F score of 96.0 % for identifying "Adverse Drug Reaction". The Classifier Chains in conjunction with Naïve Bayes are the outperformed algorithm in another dataset, with an overall F score of 43.2 % and the highest F score of 64.0 % for identifying "Medication". During the RCA, human experts applied the optimized presentation of information which showed advantages of identifying system vulnerabilities. CONCLUSION Our study demonstrated the feasibility of using multilabel text classification for identifying safety-related information from the narrative description of patient safety events. The extracted information when grouped by safety-related information can better aid human experts to conduct systems-centered RCA and disclose system vulnerabilities.
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Affiliation(s)
- Chen Liang
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Sicheng Zhou
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States
| | - Bin Yao
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States
| | - Donna Hood
- Division of Nursing, Louisiana Tech University, Ruston, LA, United States
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, United States.
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7
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Sabir FRN, Tomlinson J, Strickland-Hodge B, Smith H. Evaluating the Connect with Pharmacy web-based intervention to reduce hospital readmission for older people. Int J Clin Pharm 2019; 41:1239-1246. [PMID: 31392581 PMCID: PMC6800861 DOI: 10.1007/s11096-019-00887-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022]
Abstract
Background The patient transition from a hospital to a post-discharge healthcare setting has potential to disrupt continuity of medication management and increase the risk of harm. “Connect with Pharmacy” is a new electronic web-based transfer of care initiative employed by Leeds Teaching Hospitals NHS Trust. This allows the sharing of discharge information between the hospital and a patient’s chosen community pharmacy. Objective We investigated whether the timely sharing of discharge information with community pharmacies via “Connect with Pharmacy” reduced hospital readmission rates in older patients. Method To evaluate intervention efficacy, hospital admission data was retrospectively collected. For primary analysis, admission rates were tracked 6-months prior (baseline) and 6-months post-intervention. Secondary measures included effect on total length of stay if readmitted, emergency department attendance and duration, and impact of polypharmacy. Main outcome measure The rate of non-elective hospital readmissions, 6-months post-intervention. Results In the sample (n = 627 patients; Mean age = 81 years), emergency readmission rates following the intervention (M = 1.1, 95% CI [0.98, 1.22]) reduced by 16.16% relative to baseline (M = 1.31, 95% CI [1.21, 1.42]) (W = 54,725; p < 0.001). There was no reduction in total length of stay. Subsidiary analysis revealed a post-intervention reduction in number of days spent in hospital lasting more than three days (χ2 = 13.37, df = 1, p < 0 .001). There were no statistically reliable differences in the remaining secondary measures. Conclusion The results showed a reduction in readmissions and potential post-intervention length of stay, indicating there may be further benefits for our older patients’ experiences and hospital flow.
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Affiliation(s)
- Fatima R N Sabir
- Medicines Management and Pharmacy Services, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK.,School of Healthcare, University of Leeds, Leeds, UK
| | - Justine Tomlinson
- Medicines Management and Pharmacy Services, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK. .,School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK.
| | | | - Heather Smith
- Medicines Management and Pharmacy Services, St James University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, West Yorkshire, LS9 7TF, UK
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Botros S, Dunn J. Implementation and spread of a simple and effective way to improve the accuracy of medicines reconciliation on discharge: a hospital-based quality improvement project and success story. BMJ Open Qual 2019; 8:e000363. [PMID: 31428702 PMCID: PMC6683109 DOI: 10.1136/bmjoq-2018-000363] [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: 02/19/2018] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 11/03/2022] Open
Abstract
Background Changes are often made to medications at times of transitions in care. Inadequate reconciliation during admission, transfer and discharge causes medication errors and increases risks of patient harm. Despite well-established multidisciplinary medicines reconciliation (MR) processes at hospital admission, our MR process at discharge; however, was poor. The main errors included failure to recommence withheld medicines and lack of documentation explaining changes made to medications on discharge. Our objective was to develop an intervention that supports prescribers to follow a simple standardised MR process at discharge to reduce these errors. Methods Working closely as a multidisciplinary team, we used improvement methodologies to design and test a process that reliably directs prescribers in surgery to use the inpatient prescribing chart as well as the MR on admission form as sources to create accurate discharge prescriptions. The project was segmented into testing, implementation, spread and sustainability. Results The tested intervention helped the accuracy of discharge prescriptions steadily and quickly improve from 45% to 96% in the pilot ward. Following the successful implementation and sustainability in two separate pilot wards, the intervention was spread to the remaining eight wards producing a similar improvement. Conclusions To improve patient safety, it is crucial to ensure that information about medicines is effectively communicated when care is transferred between teams. Although this can be challenging, we've shown that it can be done effectively and reliably if this responsibility is equally shared by healthcare professionals from all disciplines while being supported by safe systems that make it easy to do the right thing. Successfully implementing a standardised multidisciplinary MR process at discharge can also reduce the reliance on pharmacists therefore freeing them to undertake other clinical roles.
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Byrne C, Sierra H, Tolhurst R. Does a checklist reduce the number of errors made in nurse-assembled discharge prescriptions? ACTA ACUST UNITED AC 2017; 26:464-467. [DOI: 10.12968/bjon.2017.26.8.464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Corrine Byrne
- Senior Clinical Pharmacist—Trauma, Emergency and Medicine, King's College Hospital NHS Foundation Trust, London
| | - Hannah Sierra
- Senior Clinical Pharmacist—Trauma, Emergency and Medicine, King's College Hospital NHS Foundation Trust, London
| | - Rowan Tolhurst
- Lead Pharmacist for Adult Cystic Fibrosis and Respiratory–Trauma, Emergency and Medicine, King's College Hospital NHS Foundation Trust, London
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10
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Hockly M, Williams S, Allen M. Transfer of care – a randomised control trial investigating the effect of sending the details of patients’ discharge medication to their community pharmacist on discharge from hospital. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:174-182. [DOI: 10.1111/ijpp.12364] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 02/10/2017] [Indexed: 11/30/2022]
Abstract
Abstract
Objective
There is substantial evidence demonstrating that transferring patients between care providers is a high-risk area for medicines management. This study aimed to investigate the effect of sending patients’ hospital discharge letters to their nominated community pharmacists on the number of discrepancies between the patient’s general practitioner (GP) records and the discharge letter and between the patient’s self-described medication regime and the discharge letter.
Methods
In a randomised, controlled trial, 33 participants in two groups, control and intervention, had their discharge letter sent to either their GP only or their GP and nominated community pharmacy after hospital discharge. At least 3 weeks after hospital discharge, the participant’s current GP’s medication record and their self-described medication regime was obtained. Discrepancies between their GP medication record and their discharge letter and between the participant’s self-described medication regime and their discharge letter were counted. The number of discrepancies (relative to the number of drugs prescribed) in the intervention group was compared with the control group for each of the above two categories, using the chi-squared test to determine the statistical significance of any differences between the two groups.
Results
The intervention group had statistically fewer discrepancies than the control group for both data sets: GP records compared with the discharge letters (P < 0.0005); participants’ self-described medication regimes compared with the discharge letters (P < 0.00005).
Conclusions
Sending a copy of patients’ discharge letters to their community pharmacists could be beneficial in reducing post-discharge prescribing discrepancies and improving patient understanding of the changes made to their medicines.
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Affiliation(s)
- Megan Hockly
- Pharmacy Department, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, UK
| | - Sian Williams
- School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, UK
| | - Marcus Allen
- Brighton and Sussex Centre for Medicines Optimisation, School of Pharmacy and Biomolecular Science, University of Brighton, Brighton, UK
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11
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Phipps DL, Morris RL, Blakeman T, Ashcroft DM. What is involved in medicines management across care boundaries? A qualitative study of healthcare practitioners' experiences in the case of acute kidney injury. BMJ Open 2017; 7:e011765. [PMID: 28100559 PMCID: PMC5253539 DOI: 10.1136/bmjopen-2016-011765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To examine the role of individual and collective cognitive work in managing medicines for acute kidney injury (AKI), this being an example of a clinical scenario that crosses the boundaries of care organisations and specialties. DESIGN Qualitative design, informed by a realist perspective and using semistructured interviews as the data source. The data were analysed using template analysis. SETTING Primary, secondary and intermediate care in England. PARTICIPANTS 12 General practitioners, 10 community pharmacists, 7 hospital doctors and 7 hospital pharmacists, all with experience of involvement in preventing or treating AKI. RESULTS We identified three main themes concerning participants' experiences of managing medicines in AKI. In the first theme, challenges arising from the clinical context, AKI is identified as a technically complex condition to identify and treat, often requiring judgements to be made about renal functioning against the context of the patient's general well-being. In the second theme, challenges arising from the organisational context, the crossing of professional and organisational boundaries is seen to introduce problems for the coordination of clinical activities, for example by disrupting information flows. In the third theme, meeting the challenges, participants identify ways in which they overcome the challenges they face in order to ensure effective medicines management, for example by adapting their work practices and tools. CONCLUSIONS These themes indicate the critical role of cognitive work on the part of healthcare practitioners, as individuals and as teams, in ensuring effective medicines management during AKI. Our findings suggest that the capabilities underlying this work, for example decision-making, communication and team coordination, should be the focus of training and work design interventions to improve medicines management for AKI or for other conditions.
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Affiliation(s)
- Denham L Phipps
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, The University of Manchester, Manchester, UK
| | - Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Tom Blakeman
- Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
- NIHR Greater Manchester Collaborative for Leadership in Applied Health Reserach and Care, The University of Manchester, Manchester, UK
| | - Darren M Ashcroft
- NIHR Greater Manchester Patient Safety Translational Research Centre, The University of Manchester, Manchester, UK
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, The University of Manchester, Manchester, UK
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12
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Marvin V, Kuo S, Poots AJ, Woodcock T, Vaughan L, Bell D. Applying quality improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital. BMJ Open 2016; 6:e010230. [PMID: 27288369 PMCID: PMC4908889 DOI: 10.1136/bmjopen-2015-010230] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES Reliable reconciliation of medicines at admission and discharge from hospital is key to reducing unintentional prescribing discrepancies at transitions of healthcare. We introduced a team approach to the reconciliation process at an acute hospital with the aim of improving the provision of information and documentation of reliable medication lists to enable clear, timely communications on discharge. SETTING An acute 400-bedded teaching hospital in London, UK. PARTICIPANTS The effects of change were measured in a simple random sample of 10 adult patients a week on the acute admissions unit over 18 months. INTERVENTIONS Quality improvement methods were used throughout. Interventions included education and training of staff involved at ward level and in the pharmacy department, introduction of medication documentation templates for electronic prescribing and for communicating information on medicines in discharge summaries co-designed with patient representatives. RESULTS Statistical process control analysis showed reliable documentation (complete, verified and intentional changes clarified) of current medication on 49.2% of patients' discharge summaries. This appears to have improved (to 85.2%) according to a poststudy audit the year after the project end. Pharmacist involvement in discharge reconciliation increased significantly, and improvements in the numbers of medicines prescribed in error, or omitted from the discharge prescription, are demonstrated. Variation in weekly measures is seen throughout but particularly at periods of changeover of new doctors and introduction of new systems. CONCLUSIONS New processes led to a sustained increase in reconciled medications and, thereby, an improvement in the number of patients discharged from hospital with unintentional discrepancies (errors or omissions) on their discharge prescription. The initiatives were pharmacist-led but involved close working and shared understanding about roles and responsibilities between doctors, nurses, therapists, patients and their carers.
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Affiliation(s)
- Vanessa Marvin
- Pharmacy Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Shirley Kuo
- Pharmacy Department, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Alan J Poots
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North West London (NWL), Imperial College London, London, UK
| | - Tom Woodcock
- NIHR CLAHRC NWL, Imperial College London, London, UK
| | | | - Derek Bell
- Department of Acute Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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13
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Nazar H, Nazar Z, Portlock J, Todd A, Slight SP. A systematic review of the role of community pharmacies in improving the transition from secondary to primary care. Br J Clin Pharmacol 2015; 80:936-48. [PMID: 26149372 PMCID: PMC4631167 DOI: 10.1111/bcp.12718] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 06/26/2015] [Accepted: 07/05/2015] [Indexed: 11/26/2022] Open
Abstract
AIM We set out to determine the potential contribution of community pharmacists to improve the transfer of care of patients from secondary to primary care settings. METHOD We systematically reviewed the literature on interventions that involved community pharmacy post-discharge. We considered all relevant studies, including both randomized and non-randomized controlled trials, irrespective of patient population. Our primary outcome was any impact on patient and medication outcomes, while the secondary outcome was to identify intervention characteristics that influenced all reported outcomes. RESULTS We retrieved 14 studies that met our inclusion criteria. There were four studies reporting outcomes relating to the identification and rectification of medication errors that were significantly improved with community pharmacy involvement. Other patient outcomes such as medication adherence and clinical control were not unanimously positively or negatively influenced via the inclusion of community pharmacy in a transfer of care post-discharge intervention. Some inconsistencies in implementation and process evaluation of interventions were found across the reviewed studies. This limited the accuracy with which true impact could be considered. CONCLUSIONS There is evidence that interventions including a community pharmacist can improve drug related problems after discharge. However, impact on other outcomes is not consistent. Further studies are required which include process evaluations to describe fully the context of the intervention so as to determine better any influencing factors. Also applying more stringent controls and closer adherence to protocols in both intervention and control groups would allow clearer correlations to be made between the intervention and the outcomes.
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Affiliation(s)
- Hamde Nazar
- School of Medicine, Pharmacy and Health, Durham UniversityQueen's Campus, Stockton, TS17 6BH
| | - Zachariah Nazar
- School of Pharmacy and Biomedical Sciences, University of PortsmouthWhite Swan Road, Portsmouth, PO1 2DT
| | - Jane Portlock
- School of Pharmacy and Biomedical Sciences, University of PortsmouthWhite Swan Road, Portsmouth, PO1 2DT, UK
| | - Adam Todd
- School of Medicine, Pharmacy and Health, Durham UniversityQueen's Campus, Stockton, TS17 6BH
| | - Sarah P Slight
- School of Medicine, Pharmacy and Health, Durham UniversityQueen's Campus, Stockton, TS17 6BH
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14
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Lawrence DS, Masood N, Astles D, Fitzgerald CE, Bari AU. Impact of pharmacist‐led medication reconciliation on admission using electronic medical records on accuracy of discharge prescriptions. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/jppr.1091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Dona S. Lawrence
- Pharmacy Department Northern Beaches Health Service, Manly Hospital Manly Australia
| | - Noman Masood
- Pharmacy Department Northern Beaches Health Service, Manly Hospital Manly Australia
| | - Dawn Astles
- Pharmacy Department Northern Sydney Local Health District (NSLHD) Sydney Australia
| | | | - Ata Ul. Bari
- Pharmacy Department Northern Beaches Health Service, Manly Hospital Manly Australia
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15
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Ng C, Welch SA, Luddington J, Bui D, Glasson E, Richardson KL. Medication Reconciliation Challenges at Discharge from Hospital using an Electronic Medication Management System and Electronic Discharge Summaries. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2013.tb00210.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Susan A Welch
- St Vincent's Hospital, Faculty of Pharmacy; The University of Sydney
| | | | | | | | - Katrina L Richardson
- Information Technology Services Centre; St Vincent's and Mater Health; Sydney New South Wales
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16
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Fitzgibbon M, Lorenz R, Lach H. Medication reconciliation: reducing risk for medication misadventure during transition from hospital to assisted living. J Gerontol Nurs 2013; 39:22-9; quiz 30-1. [PMID: 24102104 DOI: 10.3928/00989134-20130930-02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 04/23/2013] [Indexed: 11/20/2022]
Abstract
The discharge of older adults from hospital to home has been associated with poor outcomes. It is well documented that performing medication reconciliation at every transition point is critical to ensuring patient safety, preventing unnecessary rehospitalizations, and reducing the risk for medication misadventures. However, the medication reconciliation process is not well executed in numerous institutions and possibly not at all in many assisted living facilities (ALFs). Thus, the purpose of this study was to examine medication discrepancies that occur as a result of transitioning from hospitals to ALFs and to explore the role of nurses regarding medication reconciliation in ALFs. A comparison of medication records for 80 residents ages 65 and older revealed that 86.2% of resident records had at least one medication discrepancy. These results represent an opportunity for nurses to be involved with post-acute care communication and medication reconciliation to improve safe transitions for residents in ALFs.
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17
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Buck B, Wilkinson S, Phillips H. The Complexity and Importance of Residency Precepting: A Series Introduction. Hosp Pharm 2012. [DOI: 10.1310/hpj4708-603] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Preceptor development is an area of significant challenge facing residency leadership and preceptors across the nation. This series will focus on establishing a foundation necessary for successful precepting in today's fast-paced profession. Through discussion and presentation of these materials, preceptors should be able to enhance current precepting skills and identify ways to improve preceptor development programs at their practice sites. The series will review current preceptor development programs and provide options for programs that may be struggling with where to start with preceptor development. Key topics covered will include characteristics of good precepting, generational needs, effective feedback, development of a preceptor program, and finally comparison of resident and student learning needs.
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Affiliation(s)
- Brian Buck
- University of Georgia, College of Pharmacy, Athens, Georgia
| | - Samaneh Wilkinson
- Inpatient Clinical Services, PGY-1 Residency Program, PGY-2 HSPA Residency Program, The University of Kansas Hospital, Kansas City, Kansas
| | - Holly Phillips
- PGY1 Residency Program, University of Colorado Hospital, Aurora, Colorado
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18
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Russett F. Recent Publications on Medications and Pharmacy. Hosp Pharm 2012. [DOI: 10.1310/hpj4704-317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hospital Pharmacy presents this feature to keep pharmacists abreast of new publications in the medical/pharmacy literature. Articles of interest regarding a broad scope of topics are abstracted monthly.
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Affiliation(s)
- Flint Russett
- Department of Pharmacy, St. Francis Health Center, Topeka, Kansas
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