Providing systematic detailed information on medication upon hospital discharge as an important step towards improved transitional care

Hohmann, Carina; Neumann‐Haefelin, Tobias; Klotz, J.; Freidank, Annette; Radziwill, Roland

doi:10.1111/jcpt.12140

Cited by 24 publications

(22 citation statements)

References 19 publications

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“…The transmission of information regarding medication changes is essential for improving therapeutic care after discharge and reducing medication errors [18,24,35]. The BPMDL appears to be well suited for this purpose, since usual medications were found to be missing from discharge orders.…”

Section: Discussionmentioning

confidence: 99%

“…All patients admitted to the orthopaedic surgery ward who had at least two chronic diseases and three usual medications on their BPMH were considered to benefit from a BPMDL at discharge, given the higher likelihood of medication errors occurring during hospitalization [17,18]. The BPMDL was based on the Lund Integrated Medicines Management-Discharge Information model, established and validated by pharmacists and orthopaedic surgeons.…”

Section: Implementation Of the Medication Reconciliation At Dischargementioning

confidence: 99%

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Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form

et al. 2016

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Background Medication reconciliation (MedRec) at discharge is a cumbersome but necessary process to reduce the risk of medication errors at transitions of care. The main barriers to implementing such a process are the large number of professionals involved and a lack of collaboration among caregivers. Objective This study was designed to assess the need for a medication reconciliation form at discharge in an orthopaedic surgical ward. Setting The study was conducted in the orthopaedic surgery ward among inpatients at a 407-bed French teaching hospital. Method We first performed a retrospective audit to evaluate the quality of discharge medication information in the medical record, after which a 5-week prospective study was conducted in 2013. All patients admitted to the orthopaedic surgery unit who had at least two chronic diseases and three medications underwent MedRec at discharge. We designed a Best Possible Medication at Discharge List (BPMDL) to be completed by hospital staff and transmitted to community caregivers. Mean outcome measures We assessed the completeness of medication information in the medical records, discrepancies between medications noted on the BPMDL and those prescribed on the discharge order, and the value of the BPMDL for stakeholders. Results Thirty patients were included in the study. Only 4 % of medical records contained a discharge summary with complete medication information. In 67 % of cases, treatment discontinuations at admission were justified, and medications were reintroduced before discharge, while 107 treatments (45 %) were added but not prescribed on discharge orders. Discontinuations prior to discharge were justified in 60 % of cases (treatments were ended or supportive treatment was required during hospitalization). An average of 2.1 treatments were prescribed on discharge orders (vs. 9.4 prescribed on the BPMDL). Patients, general practitioners (GP), and physicians in long-term care settings (PLTCS) rated the format, content, and readability of the BPMDL as satisfactory, and it was found to be of value for patients and PLTCS to support medication information. Because of the very low response rate among GP (10 %), we were unable to determine their satisfaction with the MedRec discharge process. Conclusion The transmission of patient medication information at discharge is often lacking. As such, the BPMDL appears to have value to both patients and community health providers. Because this study was conducted within a single surgical unit, further study in other surgical wards is needed to assess generalizability.

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Section: Discussionmentioning

confidence: 99%

Section: Implementation Of the Medication Reconciliation At Dischargementioning

confidence: 99%

Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form

et al. 2016

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“…It seems to be well understood that the clinical pharmacist has an essential role to play in the MRP and any intervention on their part is usually effective in reducing medication errors and hence adverse events . However, the full‐time participation of a pharmacist is not always possible, and it would be interesting to see whether new technologies could offer a way of facilitating communication between professionals, optimizing the time and resources available in each healthcare environment …”

Section: What Is Known and Objectivementioning

confidence: 99%

“…[16][17][18][19][20] It seems to be well understood that the clinical pharmacist has an essential role to play in the MRP and any intervention on their part is usually effective in reducing medication errors and hence adverse events. 14,21 However, the full-time participation of a pharmacist is not always possible, and it would be interesting to see whether new technologies could offer a way of facilitating communication between professionals, optimizing the time and resources available in each healthcare environment. 3 The aim of this study was therefore to analyse the effectiveness of a computerized pharmaceutical intervention to reduce reconciliation errors at discharge in a cardio-pneumology unit and to characterize the type and seriousness of the errors identified.…”

Section: What Is Known and Objectivementioning

confidence: 99%

Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study

et al. 2016

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“…The time available for discharge preparation has been significantly reduced [26]. A wide range of initiatives to improve the DP have been created, including; education and training for personnel in DP [27, 28], specification of roles for people performing the DP e.g., the discharge planner [29], specific discharge screening tools and models [30, 31], standardized discharge letters [32], and medication reconciliation [23]. Implementations of information and communication technology (ICT) solutions to support the information exchange are also common [33].…”

Section: Introductionmentioning

confidence: 99%

Process evaluation of discharge planning implementation in healthcare using normalization process theory

Nordmark

Zingmark

Lindberg

2016

BMC Med Inform Decis Mak

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BackgroundDischarge planning is a care process that aims to secure the transfer of care for the patient at transition from home to the hospital and back home. Information exchange and collaboration between care providers are essential, but deficits are common. A wide range of initiatives to improve the discharge planning process have been developed and implemented for the past three decades. However, there are still high rates of reported medical errors and adverse events related to failures in the discharge planning. Using theoretical frameworks such as Normalization Process Theory (NPT) can support evaluations of complex interventions and processes in healthcare. The aim of this study was to explore the embedding and integration of the DPP from the perspective of registered nurses, district nurses and homecare organizers.MethodsThe study design was explorative, using the NPT as a framework to explore the embedding and integration of the DPP. Data consisted of written documentation from; workshops with staff, registered adverse events and system failures, web based survey and individual interviews with staff.ResultsUsing the NPT as a framework to explore the embedding and integration of discharge planning after 10 years in use showed that the staff had reached a consensus of opinion of what the process was (coherence) and how they evaluated the process (reflexive monitoring). However, they had not reached a consensus of opinion of who performed the process (cognitive participation) and how it was performed (collective action). This could be interpreted as the process had not become normalized in daily practice.ConclusionThe result shows necessity to observe the implementation of old practices to better understand the needs of new ones before developing and implementing new practices or supportive tools within healthcare to reach the aim of development and to accomplish sustainable implementation. The NPT offers a generalizable framework for analysis, which can explain and shape the implementation process of old practices, before further development of new practices or supportive tools.

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Providing systematic detailed information on medication upon hospital discharge as an important step towards improved transitional care

Abstract: The use of a structured medication report as part of the discharge letter leads to improved adherence to hospital discharge medication.

Cited by 24 publications

References 19 publications

Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form

Medication at discharge in an orthopaedic surgical ward: quality of information transmission and implementation of a medication reconciliation form

Computerized pharmaceutical intervention to reduce reconciliation errors at hospital discharge in Spain: an interrupted time-series study

Process evaluation of discharge planning implementation in healthcare using normalization process theory

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