General medical patients from an east London teaching hospital were recruited into intervention and comparison groups. Those recruited into the intervention group were given a copy of a letter listing their drugs prescribed at discharge and asked to give it to their regular community pharmacist when they went to obtain their prescribed drugs following hospital discharge. A comparison group returned home without a letter for their community pharmacist. Recruited patients were visited in their own homes once their community supply of drugs had been obtained. The frequency of all discrepancies between the prescribed drugs were compared for both groups. A consensus panel judged the importance of the discrepancies observed. The numbers deemed as clinically significant were compared for both groups, as the effect of the intervention. The 501 patients followed up (264 in the intervention group and 237 in the comparison group) were prescribed 2,736 drugs. The number of unintentional discrepancies observed was lower for the intervention group (32.2 per cent, 454/1,408) than for the : omparison group (52.7 per cent, 700/1,328) (chi-squared 117.38, P

No abstract

Objectives: Medicines reconciliation is an effective way of reducing errors at transitions of care. Much of the focus has been on medicines reconciliation at point of admission to hospital. Our objective was to evaluate medicines reconciliation after discharge from hospital by assessing the quality of information regarding medicines within discharge summaries and determining whether the information provided regarding medicines changes were acted upon within 7 days of receiving the discharge information. Methods: A retrospective collaborative evaluation of medicines related discharge information by Clinical Commissioning Group (CCG) pharmacists using standardised data collection tools. Outcomes of interest included compliance with national minimum standards for medication related information on discharge summaries, such as allergies, changes to medication regimen, minimum prescription standards e.g. dose, route, formulation and duration, and medicines reconciliation by the primary care team. Data was analysed centrally. Results: 43 CCGs covering each of the four NHS Regions in England participated in the study and submitted data for 1454 patients and 10,038 prescribed medicines. The majority of medication details were stated in accordance with standards with the exception of indication (11.7% compliance), formulation (60.3% compliance) and instructions of ongoing use (72.5% compliance). Documentation about changes was poor: 1550/3164 (49%) newly started medicines, 186/477 (39%) dose changes, and 420/738 (57%) stopped medicines had a reason documented. Changes were not acted upon within 7 days of receiving the discharge information for 12.5% of patients. Conclusions: Our evaluation revealed overall good compliance with discharge medication documentation standards, but a number of changes to medicines during hospitalisation were not fully communicated or documented on the discharge summary or actioned in the General Practice after discharge. Key Messages What is already known on this subject  Medicines Reconciliation rates on admission to hospital is a key performance indicator for the majority of NHS trusts in England  Poor communication of medicines related issues during transfer of care is a patient safety concern  Evidence form primary care studies demonstrate that General Practitioners have concerns around the quality of information provided by secondary care around medication changes What this study adds  First England-wide evaluation of the quality of discharge information about medicines  There continues to be poor communication to GPs particularly around documented reasons for changes to medication  Some changes are documented incorrectly on the GP systems

No abstract

Adverse events related to unsafe medication practices remains a leading cause of avoidable injury and mortality. Although there is vast evidence to support clinical pharmacy services in improving medication safety, pharmacy departments in Sri Lankan government hospitals still primarily manage the distribution and provision of medicines. Acknowledging this, a Hospital Pharmacists' Workshop was organised to identify factors that may impede clinical pharmacy services and medication safety practices in Sri Lanka, and further, collate recommendations to overcome these factors. A representative sample of Chief Pharmacists from hospitals around the workshop location of Kandy, representatives of the Society of Government Pharmacists (SGP) and Pharmaceutical Society of Sri Lanka (PSSL) were invited as a sample of convenience attended the workshop hosted by the University of Peradeniya. The workshop was facilitated by experienced pharmacists visiting on behalf of the Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER) group. Delegates were divided into groups for facilitator led discussions. Issues, solutions and recommendations were discussed and agreed upon as one large cohort. The consensus objective identified by attendees was to support government pharmacists in recognising and improving identified patient, pharmacist and system factors that hinder the implementation of clinical pharmacy services. Developing and promoting the