An audit of medication information in electronic discharge summaries for older patients discharged from medical wards at a regional hospital

Abstract

Background: Continuity of medication management relies on accurate and complete medication information being communicated at transitions of care. Polypharmacy and older age are risk factors for medication-related events on discharge from hospital. Aim: To determine the type and number of discrepancies in the medication information included in electronic discharge summaries prepared for older patients discharged from the medical wards of a regional hospital when compared to the National Inpatient Medication Chart (NIMC) or discharge prescription used for medication supply. Method: Patients aged 65 years or older, taking three or more regular medications, and who were discharged from the medical wards with an NIMC or discharge prescription, and an electronic discharge summary, were identified, and discrepancies between the two sources of information recorded. A severity assessment code matrix was used to assess the potential clinical significance of the discrepancies. Results: Fifty patients were included in the audit. Sixty-eight percent (34) of the discharge summaries contained one or more discrepancies with a total of 107 discrepancies identified. Almost half (43%) of the discrepancies related to medications prescribed being omitted from the electronic discharge summary. Of the discrepancies, 29% were classified as having moderate potential clinical significance, and 50% as having minor clinical significance. Discussion: This audit demonstrated that the majority of electronic discharge summaries supplied by the hospital contained discrepancies. Improved communication between healthcare providers at transitions of care is needed in rural settings.