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

Hill, Alison; Wilcock, Michael

doi:10.1007/s11096-021-01300-8

Cited by 4 publications

(3 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…66 The introduction of a healthy living pharmacy framework can make a positive impact on community pharmacy services, enabling them to provide more services according to local need. 66 Other services with significant pharmacy involvement that aim to improve the quality of patient care include the discharge medicines service, new medicines service and structured 67,68 Pharmacists usually based in general practitioner (GP) practices can offer holistic structured medication reviews; however, consistent with the pressures facing GPs, time and resource constraints in the current operating environment may limit the extent of the support that pharmacists are able to provide.…”

mentioning

confidence: 99%

The Importance of Self-Management in the Context of Personalized Care in COPD

Cravo¹,

Attar²,

Freeman³

et al. 2022

COPD

View full text Add to dashboard Cite

Despite current guidelines and decades of evidence on the benefits of a self-management approach, self-management of COPD remains relatively under-utilized in clinical care compared with other chronic diseases. However, self-management interventions can play a valuable role in supporting people with COPD to respond to changing symptoms, and thereby make appropriate decisions regarding the management of their own chronic condition. In this review, we discuss the history and evolution of the concept of self-management, assess current multidisciplinary support programs and clinical interactions designed to optimize self-management, and reflect on how effective these are in terms of clinical and humanistic outcomes. We also evaluate the mechanisms for encouraging change from protocol-based care towards a more personalized care approach, and discuss the role of digital self-management interventions and the importance of addressing health inequalities in COPD treatment, which have been accelerated by the COVID-19 pandemic. Reflecting on the importance of self-management in the context of symptom monitoring and provision of educational support, including information from patient organizations and charities, we discuss the ideal components of a self-management plan for COPD and provide six key recommendations for its implementation: 1) better education for healthcare professionals on disease management and consultation skills; 2) new targets and priorities for patient-focused outcomes; 3) skills gap audits to identify barriers to self-management; 4) best practice sharing within primary care networks and ongoing professional development; 5) enhanced initial consultations to establish optimal self-management from the outset; and 6) negotiation and sharing of self-management plans at the point of diagnosis.

show abstract

mentioning

confidence: 99%

The Importance of Self-Management in the Context of Personalized Care in COPD

Cravo¹,

Attar²,

Freeman³

et al. 2022

COPD

View full text Add to dashboard Cite

show abstract

“…Proportion of admission MR within 24-h increased, with greatest impact for Saturday admissions, reflecting significant changes made to the Saturday afternoon and Sunday services. Implementation provided capacity for CP-led preparation of weekend discharge medicines lists, which improves communication of discharge MR information to primary care [48]. This is the first study we are aware of to give direct evidence in terms of patient benefit for a seven-day clinical pharmacy service.…”

Section: Discussionmentioning

confidence: 99%

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic

et al. 2022

View full text Add to dashboard Cite

Background Seven-day clinical pharmacy services in the acute sector of the National Health Service are limited. There is a paucity of evidential patient benefit. This limits investment and infrastructure, despite United Kingdom wide calls. Aim To optimise medicines seven-days a week during surge-2 of the COVID-19 pandemic through implementation of a seven-day clinical pharmacy service. This paper describes service development, evaluation and sustainability. Setting A tertiary-referral teaching hospital, London, United Kingdom. Development The seven-day clinical pharmacy service was developed to critical care, acute and general medical patients. Clinical leads developed the service specification and defined priorities, targeting complex patients and transfer of care. Contributing staff were briefed and training materials developed. Implementation The service was implemented in January 2021 for 11 weeks. Multidisciplinary team communication brought challenges; strategies were employed to overcome these. Evaluation A prospective observational study was conducted in intervention wards over two weekends in February 2021. 1584 beds were occupied and 602 patients included. 346 interventions were reported and rated; 85.6% had high or moderate impact; 56.7% were time-critical. The proportion of medicines reconciliation within 24-h of admission was analysed across the hospital between November 2020 and May 2021. During implementation, patients admitted Friday-Sunday were more likely to receive medicines reconciliation within 24-h (RR 1.41 (95% CI 1.34–1.47), p < 0.001). Rostered services were delivered sustainably in terms of shift-fill rate and medicines reconciliation outcome. Conclusion Seven-day clinical pharmacy services benefit patient outcome through early medicines reconciliation and intervention. Investment to permanently embed the service was sustained.

show abstract

“…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

View full text Add to dashboard Cite

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.

show abstract

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

Cited by 4 publications

References 15 publications

The Importance of Self-Management in the Context of Personalized Care in COPD

The Importance of Self-Management in the Context of Personalized Care in COPD

Development, implementation and evaluation of a seven-day clinical pharmacy service in a tertiary referral teaching hospital during surge-2 of the COVID-19 pandemic

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

Contact Info

Product

Resources

About