Insights into British Columbian Hospital Pharmacists Perspectives on the Discharge Process

What Patients Want: A Qualitative Study of Patients' Perspectives on Optimizing the Hospital Discharge Process

Background

Poor discharge planning can lead to increases in adverse drug events, hospital readmissions, and costs. Prior research has identified the pharmacist as an integral part of the discharge process.

Objectives

To gain patients' perspectives on the discharge process and what they would like pharmacists to do to ensure a successful discharge.

Methods

Twenty patients discharged from tertiary care hospitals were interviewed after discharge. A phenomenological approach was used to conduct this qualitative study.

Results

Five main themes were identified from the patient interviews: interactions with health care professionals, importance of discharge documentation, importance of seamless care, comprehensive and patient-specific medication counselling, and patients' preference for involvement and communication at all stages of hospital stay.

Conclusions

Although participants generally reported positive interactions with health care providers at discharge, several areas for improvement were identified, particularly in terms of communication, discharge documentation, and continuity of care. A list of recommendations aligning with patient preferences is provided for clinicians.

Optimizing the Hospital Discharge Process: Perspectives of the Health Care Team

Background

Prior research capturing pharmacists' perspectives on the discharge process has shown that their involvement is essential. Given the multidisciplinary nature of the hospital environment, it is important to understand the perspectives of nonpharmacist health care providers.

Objectives

To explore the perspectives of nonpharmacist health care providers concerning current discharge practices, components of an effective discharge plan, and perceived barriers to an optimal discharge, and to explore their expectations of pharmacists at discharge.

Methods

This qualitative study used key informant interviews of allied health professionals and prescribers at Vancouver General Hospital and North Island Hospital Comox Valley (British Columbia). Participants primarily working on general medicine, family practice, or hospitalist wards were invited to participate.

Results

A total of 16 health care providers participated, consisting of 12 allied health professionals and 4 prescribers. Thematic analysis of the interview transcripts revealed 5 themes for each group. The following 3 themes were common to both groups: systems-related barriers to an optimal discharge; patient- and community-related barriers to an optimal discharge; and patient involvement and education. For allied health professionals, themes of prioritization of patients for discharge and direct communication/teamwork were also key for an optimal discharge. Prescriber-specific themes were limitations related to technology infrastructure and inefficiency of existing collaborative processes. Key responsibilities expected of the pharmacist at discharge included preparing the discharge medication reconciliation and prescriptions, addressing medication-related cost concerns, organizing adherence aids/tools, and providing medication counselling.

Conclusions

Further studies are warranted to investigate optimization of the discharge process through implementation of standardized discharge protocols and electronic health record-related tools. The primary responsibilities of the pharmacist at discharge, as perceived by study participants, were consistent with previous literature.

Characterizing Current and Optimal Involvement of Hospital Pharmacists in the Discharge Process: A Survey of Pharmacists in British Columbia

Background

Transitions of care represent a vulnerable time when patients are at increased risk of medication errors. Medication-related problems constitute one of the main contributors to hospital readmissions. Discharge interventions carried out by pharmacists have been shown to reduce hospital readmissions. Although clinical pharmacists in British Columbia are involved in discharges, their degree of involvement and the interventions they prioritize in practice have not been fully elucidated.

Objectives

To characterize the current involvement of BC hospital pharmacists at the time of discharge, to identify which discharge interventions they believe should be prioritized, and who they feel should be responsible for these interventions, as well as to identify strategies to optimize the discharge process.

Methods

A survey of BC hospital pharmacists was conducted in January and February 2022. The survey included questions about pharmacists' current involvement at the time of discharge, interventions required for a successful discharge, solutions for optimizing the patient discharge process, and participants' baseline characteristics.

Results

The survey response rate was 20% (101/500). Pharmacists reported performing all interventions for less than 60% of their patients. Interventions such as medication reconciliation on discharge, medication education, and ensuring adherence were considered very important for a successful discharge and were considered to be best performed by pharmacists. Solutions for optimizing the discharge process included improved staffing, weekend coverage, timely notification of discharge, and prescribing by pharmacists.

Conclusions

Despite the belief that most interventions listed in the survey are necessary for successful discharge, various barriers prevented pharmacists from providing them to all patients. Increased resources and expanded scope of practice for pharmacists could reduce hospital readmissions and enable broader implementation of discharge interventions.