Hospitals do not inform GPs about medication that should be monitored

BackgroundDischarge from hospital presents significant risks to patient safety, with up to one in five patients experiencing adverse events within 3 weeks of leaving hospital.AimTo describe the frequency and types of patient safety incidents associated with discharge from secondary to primary care, and commonly described contributory factors to identify recommendations for practice.Design and settingA mixed methods analysis of 598 patient safety incident reports in England and Wales related to ‘Discharge’ from the National Reporting and Learning System.MethodDetailed data coding (with 20% double-coding), data summaries generated using descriptive statistical analysis, and thematic analysis of special-case sample of reports. Incident type, contributory factors, type, and level of harm were described, informing recommendations for future practice.ResultsA total of 598 eligible reports were analysed. The four main themes were: errors in discharge communication (n = 151; 54% causing harm); errors in referrals to community care (n = 136; 73% causing harm); errors in medication (n = 97; 87% causing harm); and lack of provision of care adjuncts such as dressings (n = 62; 94% causing harm). Common contributory factors were staff factors (not following referral protocols); and organisational factors (lack of clear guidelines or inefficient processes). Improvement opportunities include developing and testing electronic discharge methods with agreed minimum information requirements and unified referrals systems to community care providers; and promoting a safety culture with ‘safe discharge’ checklists, discharge coordinators, and family involvement.ConclusionSignificant harm was evident due to deficits in the discharge process. Interventions in this area need to be evaluated and learning shared widely.

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“…41 Specifically, communication errors around medications, especially warfarin, are well described in the literature. 42 – 45 …”

Section: Discussionmentioning

confidence: 99%

Harms from discharge to primary care: mixed methods analysis of incident reports

et al. 2015

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“…After being discharged from the hospital, patients often contact their GP [16]. The late or non-arrival of information and the failure to inform GPs about changes in the pharmacotherapy could lead to the continuation of medication errors in primary care [1, 2, 5, 6, 13, 17]. Studies reported that 77–96% GPs want to know why medication is changed or discontinued, which is consistent with the results in our study [1, 13].…”

Section: Discussionmentioning

confidence: 99%

“…These changes can be caused by for example alterations in disease state or the need for increased drug efficacy [1]. Medical care in chronic illness is moving increasingly from secondary to primary care [5]. The general practitioner (GP), who is responsible for the patient after discharge, must decide whether or not to maintain these changes, often without valid information with respect to the reasons for these changes [6].…”

Section: Introductionmentioning

confidence: 99%

Informational needs of general practitioners regarding discharge medication: content, timing and pharmacotherapeutic advices

et al. 2010

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Objective To investigate the needs of Dutch general practitioners on discharge medication, both regarding content, timing and the appreciation of pharmacotherapeutic advices from clinical pharmacists. Setting A general teaching hospital in Amsterdam, the Netherlands. Method A prospective observational study was performed. A questionnaire with regard to the content, optimal timing (including way of information transfer) and appreciation of pharmacotherapeutic advices was posted to 464 general practitioners. One reminder was sent. Main outcome measure Description of the needs of general practitioners was assessed. For each question and categories of comments frequency tables were made. The Fisher-exact test was used to study associations between the answers to the questions. Results In total, 149 general practitioners (32%) responded. Most general practitioners (75%) experienced a delay in receiving discharge medication information and preferred to receive this on the day of discharge. GPs wished to receive this information mainly through e-mail (44%). There was a significant correlation (P = 0.002) between general practitioners who wanted to know whether and why medication had been stopped (87%) and changed (88%) during hospital admission. The general practitioners (88%) appreciated pharmacotherapeutic advices from clinical pharmacists. Conclusion This study indicates how information transfer on discharge medication to GPs can be optimised in the Netherlands. The information arrives late and GPs want to be informed on the day of discharge mainly by e-mail. GPs wish to know why medication is changed or discontinued and appreciate pharmacotherapeutic advices from clinical pharmacists.

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“…Another study, conducted in Northern Ireland, investigated hospital letters for patients discharged with potentially risky drug therapies requiring regular monitoring. Only 17% of the letters indicated the need for regular monitoring [23]. The lack of information in letters could be due to an overestimation of the knowledge held by the GP about a specific drug treatment.…”

Section: Discussionmentioning

confidence: 99%

Secondary care doctors' perception of appropriate prescribing

Ljungberg

Lindblad

Tully

2009

Evaluation Clinical Practice

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Hospitals do not inform GPs about medication that should be monitored

Abstract: The information provided in hospital letters is insufficient to allow GPs to put structures in place to monitor drug therapy.

Cited by 10 publications

References 3 publications

Harms from discharge to primary care: mixed methods analysis of incident reports

Harms from discharge to primary care: mixed methods analysis of incident reports

Informational needs of general practitioners regarding discharge medication: content, timing and pharmacotherapeutic advices

Secondary care doctors' perception of appropriate prescribing

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