Ensuring explanations for changes to medication therapy in the discharge summary

A Quality Improvement Program Presenter

Insert your hospital logo here QUM Indicator 5.3

Overview

• Background • Aims and methods • Educational Intervention • Results • Questions & Discussion

Explaining changes on the discharge medicines list

What is the purpose of the discharge summary?

Frequently, the discharge summary is the

only

communication provided to the General Practitioner (GP) about their patients and the events that occurred whilst their patients’ were in hospital.

Explaining changes on the discharge medicines list

Medication Error and ADEs

• Transferring patients are those most vulnerable.

1 • Poor quality communication 1

Explaining changes on the discharge medicines list

Identified gaps in practice

• “Inaccurate, incomplete and illegible” information are common deficiencies within the discharge summary 2 In the medicines list: -Omitted medications 3,4 -Medication not previously prescribed (or justified) 3,4

Explaining changes on the discharge medicines list

Aims

1.

To use drug use evaluation (DUE) methodology to describe the extent to which explanations for medicine therapy changes are being documented in discharge summaries from participating NSW and ACT hospitals.

2. To increase awareness of the APAC Guiding Principles within the hospital setting, in particular “communicating medicines information” (Guiding Principle 9).

5 3. To optimise the discharge summary as a communication tool to General Practitioners (GPs) on explanations for alterations to patients’ medicine therapy.

Explaining changes on the discharge medicines list

Defining “changes” to and “explanations” for medication therapy?

Refers to changes to the patient’s pre-admission regimen which are intended to continue after discharge 2 – New medication – Change in the dose, form, route or frequency of a medicine taken prior to admission – Cessation of a medicine taken prior to admission Explanations for changes: Should include sufficient detail to inform future management decisions in the discharge summary or discharge letter.

Explaining changes on the discharge medicines list

DUE Methodology

Feedback

SHPA Drug Use Evaluation Cycle 6

Explaining changes on the discharge medicines list

Program Methods

August 2010

Ethics approval Support from senior clinicians Data collection

June 2011

Education and Feedback Data collection Evaluation, Feedback and Sustainability

Explaining changes on the discharge medicines list

Educational Intervention

• Involved educational and system changes – Location of documented Best Possible Medication History – Discharge Summary Medication Checklist for Term Supervisors – Lanyard Cards – Discharge Summary Workshop(s) – Other

Explaining changes on the discharge medicines list

Pre and Post-intervention results

Patients discharged where a discharge summary is documented in the notes Patients who had medication reconciliation undertaken on admission Discharge summaries which comply with NSW Policy (PD2007_092) for a documented list of medications on admission and on discharge Hospital Baseline NSW/ACT Baseline Hospital Post intervention 506/538

(94.1%)

272/52 #

(51.6%)

126/506

(24.9%)

Explaining changes on the discharge medicines list

Pre and Post-intervention results continued

Hospital NSW/ACT Baseline Baseline Discharge summaries which should have explanations for medicine therapy changes Discharge summaries which document all changes to medicine therapy Number of medicine therapy changes which require an explanation Of those, proportion which had a documented explanation for the change 434/506

(85.8%)

131/434

(30.2%)

1628 619/1628

(38.0%)

Hospital Post intervention Explaining changes on the discharge medicines list

Pre and Post-intervention results continued

Hospital NSW/ACT Of the discharge summaries reviewed, those which were computer generated Baseline Baseline 460/506 (90.9%) Hospital Post Intervention Discharge summary templates prompting documentation for changes to medications Number of discharge summary templates reviewed 217/506 (42.9%) 28 Explaining changes on the discharge medicines list

Discussion

• Encouraging aspects of our results • Where to from here?

Explaining changes on the discharge medicines list

Hospital Program Contacts

• Clinical Champion: xxxxx • Local Project Team: xxxxx

Explaining changes on the discharge medicines list

.

References

1. Easton K, Morgan T, Williamson M. Medication safety in the community: A review of the literature. National Prescribing service. Sydney, June 2009. 2. Wong JD, Bajcar JM, Wong GG et al. Medication reconciliation at hospital discharge: Evaluating Discrepancies. Ann Pharmacother 2008;42:1373 1379.

3. Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential. Int J for Qual in Health Care 2005; 17(1):15-22. 4. Perren A, Previsdomini M, Cerutti B, et al. Omitted and unjustified medications in the discharge summary. Qual Saf Health Care 2009;18:205 208. 5.Guiding principles to achieve medication management: Australian Pharmaceutical Advisory Council; 2005:1-55.

6. SHPA Committee of Specialty Practice in Drug Use Evaluation. SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals. JPPR 2004; 34(3): 220-222.

Explaining changes on the discharge medicines list

Acknowledgements

• NSW TAG – SAFER Medicines Group – Drug Use Evaluation Support Group • Indicator 5.3 Expert Advisory Committee

Explaining changes on the discharge medicines list

Questions/Discussion

Explaining changes on the discharge medicines list