This quality improvement initiative to help prevent known medication-related failures during transitions of care was co-led by Patients for Patient Safety Canada, the Institute for Safe Medication Practices Canada, the Canadian Patient Safety Institute, the Canadian Pharmacists Association, and the Canadian Society for Hospital Pharmacists. Initially, the intervention was to develop, test, evaluate and disseminate a medication safety "checklist" for patients and healthcare providers. Through small tests of change, the checklist was redesigned as the "5 Questions to Ask about Your Medications." Collective results demonstrate a shared commitment among more than 200 organizations to empower patients with questions to ask about their medications.

In the United Kingdom, specialists in Geriatric Medicine usually have a major role in treating acute medical problems of elderly people, in addition to running rehabilitation services and continuing care. The proportion of the different types of patients varies widely from service to service, however, making it difficult for clinicians to compare their performance with that of colleagues. Existing casemix measurement systems are usually designed to deal with a more homogeneous patient group (e.g. rehabilitation, long-stay care) and/or are too detailed for day-to-day use. We describe our attempts to devise a simple casemix system which would be of practical day-to-day use for individual specialists in Geriatric Medicine. We have classified patients according to (1) the acuteness and potential for recovery of their presenting illness and (2) their functional status (based on simple measures of mobility and cognitive impairment). These factors have been incorporated into a three-point score, CMIX, which was capable of explaining 19.5% of the variability in duration of stay in a prospective study of 400 new admissions in two centres. In contrast, age and sex explained only 1% of variability in these patients. The pattern of patient outcome also differed significantly between the three CMIX categories. We also propose a simple graphical method of classifying outcome which should prove useful for audit purposes even when our casemix system is not employed.

<p><strong>ABSTRACT</strong></p><p><strong></strong><strong>Background:</strong> Discharge medication reconciliation (MedRec) is designed to reduce medication errors and inform patients and key postdischarge providers, but it has been difficult to implement routinely in Canadian hospitals.</p><p><strong>Objectives:</strong> To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals.<br /><strong></strong></p><p><strong>Methods:</strong> The discharge MedRec quality audit tool, developed by the Canadian Patient Safety Institute and the Institute for Safe Medication Practices Canada, was assessed and modified to improve comprehensiveness, clarity, and quality. The modified tool was then used to evaluate the quality of the discharge MedRec process for adult patients discharged to home from the general internal medicine service at 3 academic hospitals. Postdischarge telephone interviews were conducted with consenting patients, their community pharmacists, and their family doctors.<br /><strong></strong></p><p><strong>Results:</strong> The audit tool required modification to include aspects of admission MedRec, high-risk medication discrepancies, and direct communication of discharge MedRec to key follow-up providers. Thirty-five patients (mean age 67.7 years, standard deviation [SD] 18.0 years; 17 [49%] women), with a mean of 8.8 (SD 4.5) prescribed medications at discharge, participated in the discharge MedRec evaluation. Documentation of any discharge MedRec was found for only 1 patient (3%), and no discharge MedRec was carried out by pharmacists. Postdischarge follow-up interviews elicited major gaps in communication with community pharmacists and with family physicians, which could lead to serious medication errors.<br /><strong></strong></p><p><strong>Conclusions:</strong> The modified audit tool was useful for identifying gaps in the quality of discharge MedRec.</p><p><strong><br /></strong></p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte :</strong> Le bilan comparatif des médicaments (BCM) au moment du congé est conçu pour réduire les erreurs médicamenteuses et informer les patients ainsi que les principaux prestataires de soins de santé après le congé, mais sa mise en œuvre systématique dans les hôpitaux canadiens s’est heurtée à de grandes difficultés.<br /><strong></strong></p><p><strong>Objectifs :</strong> Évaluer et optimiser un nouvel outil d’évaluation de la qualité du BCM au moment du congé et l’utiliser dans trois hôpitaux universitaires urbains.<br /><strong></strong></p><p><strong>Méthodes :</strong> Cet outil développé par l’Institut canadien pour la sécurité des patients (ICSP) et l’Institut pour la sécurité des médicaments aux patients du Canada (ISMP) a fait l’objet d’une évaluation et d’une modification visant à améliorer son exhaustivité, sa clarté et sa qualité. L’outil modifié a ensuite servi à évaluer la qualité du processus du BCM pour des patients adultes ayant obtenu leur congé après un séjour dans un service général de médecine interne dans trois hôpitaux universitaires. Des entretiens téléphoniques après le congé ont été menés avec les patients consentants, leur pharmacien communautaire et leur médecin de famille.<br /><strong></strong></p><p><strong>Résultats :</strong> L’outil d’évaluation a dû être modifié pour inclure le BCM au moment de l’admission, des écarts de médication à haut risque et une communication directe du BCM aux prestataires de soins de santé principaux chargés du suivi après le congé. Trente-cinq patients (âge moyen : 67,7 ans; écart type [ET] 18 ans; 17 [49 %] femmes), chacun ayant reçu en moyenne 8,8 (ET 4,5) médicaments prescrits, ont participé à l’évaluation du BCM au congé de l’hôpital. Au moment du congé, on n’a trouvé de renseignements relatifs au BCM que pour un seul patient (3 %) et aucun BCM n’avait été préparé par les pharmaciens. Le suivi après le congé a généré des écarts de communication importants entre les pharmaciens communautaires et les médecins de famille, ce qui pourrait entraîner des erreurs médicamenteuses importantes.<br /><strong></strong></p><p><strong>Conclusions :</strong> L’outil d’évaluation modifié a été utile pour déterminer les écarts relatifs à la qualité du BCM au moment du congé.</p><p> </p>

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