Accuracy of pharmacist electronic discharge medicines review information transmitted to primary care at discharge

Wilcock, Michael; Hill, Alison; Wynn, Amber; Kelly, Liam

doi:10.1007/s11096-019-00835-1

Cited by 6 publications

(2 citation statements)

References 12 publications

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“…Pharmacists in Australia, and many other countries, are well placed to perform this activity as they already routinely perform medication reconciliation on discharge to ensure discharge medication orders are accurate, and to identify medication changes in order to communicate these to patients, carers and community pharmacies. There is evidence that pharmacists can prepare discharge medication information with a high degree of accuracy [10,19,20], and that pharmacist-led medication reconciliation leads to fewer medication discrepancies at discharge [21]. A number of studies have highlighted the benefits of involving pharmacists in preparing medical discharge summaries [18,[22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability

et al. 2019

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Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2–16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.

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Section: Introductionmentioning

confidence: 99%

Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability

et al. 2019

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“…Hospital pharmacists play a vital role in the quality of medicine handover during patients’ discharges, including patient counselling, reconciling medicines, and generating a discharge medicine list [ 2 ]. Studies conducted in a large tertiary hospital in England showed that pharmacists’ involvement in the discharge medication reconciliation process significantly improved the quality of discharge summaries [ 9 , 10 ]. A 2015 randomised controlled trial in Victoria, Australia, demonstrated hospital pharmacists’ medicine lists were more accurate compared to those prepared by discharging doctors [ 11 ]: when doctors completed medicine lists in discharge summaries, at least one medicine error was identified in 61.5% of cases, compared to 15.0% when generated by hospital pharmacists.…”

Section: Introductionmentioning

confidence: 99%

Exploring the time required by pharmacists to prepare discharge medicine lists: a time-and-motion study

et al. 2022

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Background Discharge medicine lists provide patients, carers and primary care providers a summary of new, changed or ceased medicines when patients discharge from hospital. Hospital pharmacists play an important role in preparing these lists although this process is time consuming. Aim To measure the time required by hospital pharmacists to complete the various tasks involved in discharge medicine handover. Method Time-and-motion study design was used to (1) determine the time involved for pharmacists to produce discharge medicine lists, (2) explore how pharmacists utilise various software programs to prepare lists, and (3) compare the time involved in discharge medicine handover processes considering confounding factors. An independent observer shadowed 16 pharmacists between 22 February and 12 March 2021 and recorded tasks involved in 50 discharge medicine handovers. Relevant information about each discharge was also collected. Results Pharmacists observed represented a range of practice experiences and inpatient units. Mean time to complete discharges was 26.2 min (SD 13.6), with over half of this time used to check documentation and prepare discharge medicine lists. A mean of 4.0 min was spent on manually retyping and reconciling medicine lists in different software systems. Medical inpatient unit discharges took 4.6 min longer to prepare compared to surgical ones. None of the 50 discharges involved support from pharmacy assistants; all 50 discharges had changed or ceased medicines. Conclusion There is a need to streamline current discharge processes through optimisation of electronic health software systems and better delegation of technical tasks to trained pharmacy assistants. Supplementary Information The online version contains supplementary material available at 10.1007/s11096-022-01436-1.

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Exploring pharmacist involvement in the discharge medicines reconciliation process and information transfer to primary care: an observational study

Hill

Wilcock

2021

Int J Clin Pharm

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Accuracy of pharmacist electronic discharge medicines review information transmitted to primary care at discharge

Cited by 6 publications

References 12 publications

Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability

Pharmacist–Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability

Exploring the time required by pharmacists to prepare discharge medicine lists: a time-and-motion study

Exploring pharmacist involvement in the discharge medicines reconciliation process and information transfer to primary care: an observational study

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