Transcript A Quality Use Of Medicine Program

Ensuring explanations for
changes to medication
therapy in the discharge
summary
A Quality Improvement Program
Insert your
hospital logo
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Presenter
QUM Indicator 5.3
Overview
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Background
Aims and methods
Feedback on current practices
Education- ‘Support 4 Success’
Questions
Explaining changes on the discharge medicines list
Background
• NSW Therapeutic Advisory Group (NSW TAG)
survey to identify top 3 issues in medication
safety.
-SAFER Medicines Group
-TAG and TAG Net members
• Top issue to address: Medication changes
and explanations for changes in the
discharge summary
Explaining changes on the discharge medicines list
About NSW TAG
• Independent, not-for-profit organisation
• Membership consisting of clinical
pharmacologists, pharmacists and other
clinicians from teaching hospitals
• Representatives from every Drug and
Therapeutics Committee across NSW.
• Core goal to promote the Quality Use of
Medicines
• www.nswtag.org.au
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
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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
QUM Indicator 5.3
• What are the Quality Use of Medicine (QUM) Indicators?
• QUM Indicator 5.3 aims to measure6:
Percentage of discharge summaries
that include medication therapy
changes and explanations for
changes
• Quality improvement initiative
involving 16 hospitals across NSW/ACT
Explaining changes on the discharge medicines list
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
Completing high quality discharge
summaries
National E-Health Transition Authority (NEHTA) Continuity of Care
program March 20107
Barriers include:
• devaluing of discharge summaries
• over emphasis on coding requirements
• uncertainty over what information a GP
desires
Explaining changes on the discharge medicines list
Support for quality improvement in the
discharge summary
Work toward improving the processes and forms required to
produce a quality discharge summary is underway.
Nationally:
Australian Pharmaceutical Advisory Council (APAC)
National E-Health Transition Authority (NEHTA)
Australian Commission for Safety and Quality in Health Care
Statewide:
NSW Health Systems Support
Forms committee
NSW Therapeutic Advisory Group NSW/ACT program (QUM
Indicator 5.3)
Explaining changes on the discharge medicines list
DUE Methodology
Feedback
SHPA Drug Use
Evaluation Cycle8
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
Pre-intervention results continued
Hospital
NSW/ACT
Baseline
Baseline
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
Explaining changes on the discharge medicines list
Pre-intervention results
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
Explaining changes on the discharge medicines list
Pre-intervention results continued…
Hospital
NSW/ACT
Baseline
Baseline
Of the discharge summaries reviewed,
those which were computer generated
Discharge summary templates prompting
documentation for changes to medications
Number of discharge summary templates
reviewed
Explaining changes on the discharge medicines list
Discussion
• Encouraging aspects
of our results
• Aspects to improve
Explaining changes on the discharge medicines list
EDUCATION
Explaining changes on the discharge medicines list
Educational Tools:
Expert Advisory Committee
• Clinical Education and Training Institute (CETI)
Representatives:
– JMO Forum
– Prevocational Training Council / Director Medical
Services
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Head of Department , General Paediatrics
General Practitioner
Education and Training Pharmacist
Quality Manager
Head of Department, Clinical Pharmacology
Explaining changes on the discharge medicines list
Educational Intervention Tools
• Discharge Summary Workshop
• “Top Tips” lanyard cards
• Checklist for JMO Term Supervisors
• Feedback presentation today!
Explaining changes on the discharge medicines list
Discharge Summary Workshop
• Target audience: Junior Medical Officers
• Consists of:
-PowerPoint® presentation
(Good, great and ugly discharge
summary examples)
-Practical case examples and activities
Explaining changes on the discharge medicines list
Lanyard Cards
Explaining changes on the discharge medicines list
Checklist for JMO
Term Supervisors
Explaining changes on the discharge medicines list
Support 4 Success!
Many staff members can provide support and
contribute to make this program an successful
• JMOs
• Term supervisors and their senior team
members
• Pharmacists
• Nursing
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. Indicators for Quality Use of Medicines in Australian Hospitals: NSW Therapeutic
Advisory Group, 2007.
7.Continuity of Care Program- National E-Health Transition Authority, March 2010: Issues
and barriers faced by Junior Hospital Doctors for the Implementation of the Discharge
Summary (unpublished)
8. 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