Transcript A Quality Use Of Medicine Program

Ensuring explanations for
changes to medication
therapy in the discharge
summary
A Quality Improvement Program
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hospital logo
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Presenter
QUM Indicator 5.3
Overview
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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 communication1
Explaining changes on the discharge medicines list
Identified gaps in practice
• “Inaccurate, incomplete and illegible”
information are common deficiencies
within the discharge summary2
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 discharge2
– 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 Cycle6
Explaining changes on the discharge medicines list
Program Methods
August 2010
June 2011
Ethics approval
Support from senior clinicians
Data collection
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
Hospital
NSW/ACT
Baseline
Baseline
Patients discharged where a
discharge summary is
documented in the notes
506/538
(94.1%)
Patients who had medication
reconciliation undertaken on
admission
272/52#
(51.6%)
Discharge summaries which
comply with NSW Policy
(PD2007_092) for a documented
list of medications on admission
and on discharge
126/506
(24.9%)
Hospital
Postintervention
Explaining changes on the discharge medicines list
Pre and Post-intervention results
continued
Hospital
NSW/ACT
Hospital
Baseline
Baseline
Postintervention
Discharge summaries which
should have explanations for
medicine therapy changes
434/506
(85.8%)
Discharge summaries which
document all changes to
medicine therapy
131/434
(30.2%)
Number of medicine therapy
changes which require an
explanation
1628
Of those, proportion which had a
documented explanation for the
change
619/1628
(38.0%)
Explaining changes on the discharge medicines list
Pre and Post-intervention results
continued
Hospital
NSW/ACT
Hospital
Baseline
Baseline
PostIntervention
Of the discharge summaries
reviewed, those which were
computer generated
460/506
(90.9%)
Discharge summary templates
prompting documentation for
changes to medications
217/506
(42.9%)
Number of discharge summary
templates reviewed
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;42:13731379.
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;18:205208.
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.
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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