Pharmacist contributions to ensuring safe and accurate transfer of written medicines-related discharge information: lessons from a collaborative audit and service evaluation involving 45 hospitals in England

Abstract

Objectives To audit the quality of written hospital discharge prescriptions and quantify and evaluate pharmacy contributions to ensuring discharge medication information is accurate and complete. Methods A tool was developed and piloted to audit discharge prescription information against best practice guidance. Simultaneously, pharmacist contributions to discharge prescription accuracy and completeness were recorded, classified and rated for potential clinical impact. Results were analysed according to four variables: care area; emergency or elective admission; type of prescription; place of screening.

A collaborative evaluation of pharmacy interventions in the care of inpatients in community hospitals

“…Dean and Barber found that at least four judges consisting of senior doctors, senior pharmacists and senior nurses were required to achieve reliable scores 15. In our evaluation, pharmacists self-scored the severity level according to a framework adapted from the NRLS similar to that used by Dodds 5 6. To aid consistency, participants were given written guidance on self-scoring, which included examples to provide clarity.…”

“…Where the pharmacist made an intervention from information on the medication chart, they were asked to record the name of the drug and the type of intervention from a predetermined list. Pharmacists were then asked to self-assess the clinical impact of their intervention according to a framework similar to that used by Dodds and adapted from the National Reporting and Learning System (NRLS) 5 6 Table 1. gives an overview of how the interventions were assessed, with examples given to provide clarity.…”

Medicines-related communication systems and the new NICE guidance

“…There is compelling evidence that, in the hospital setting, pharmacists or pharmacy technicians obtain the most accurate drug histories; with nonpharmacy health professionals creating 1.3 unintended discrepancies for each medicines reconciliation completed, 4 and two-thirds of discharge summary letters inaccurate prior to pharmacy screening. 5 Checklists are a great way of ensuring the right information is obtained at medicines reconciliation. Figure 1 gives one example; this elicits more than just GP prescribed information, recognising that patients obtain their medicines from many sources.…”

Using the Consolidated Framework for Implementation Research to Evaluate a New Discharge Medication Prescription Pathway

“…Seden et al (2013) reported that 34.5% of discharge prescriptions contained at least one prescribing error and in a study of prescribing errors in mental health hospitals, 6.5% of discharge medications were associated with an error (Keers et al, 2014). 68% of discharge prescriptions required correction by pharmacists in a recent large UK multi-centre study (Dodds, 2014).…”