Sandra A N Walker1, Jennifer K Lo2, Sara Compani3, Emily Ko4, Minh-Hien Le5, Romina Marchesano6, Rimona Natanson7, Rahim Pradhan4, Grace Rzyczniak4, Vincent Teo8, Anju Vyas4. 1. , BSc, BScPhm, ACPR, PharmD, FCSHP, is a Clinician Scientist and is the Pharmacy Lead in Infectious Diseases and Antimicrobial Stewardship, Sunnybrook Health Sciences Centre, Toronto, Ontario. 2. , HBSc, BScPhm, PharmD, was, at the time of this study, a pharmacy student at Sunnybrook Health Sciences Centre, Toronto, Ontario, and is now an Antimicrobial Stewardship Pharmacist (contract position) with the Department of Pharmacy at this institution. 3. , BScPhm, is a Clinical Pharmacist, Sunnybrook Health Sciences Centre, Toronto, Ontario. 4. , BScPhm, ACPR, is a Clinical Pharmacist, Sunnybrook Health Sciences Centre, Toronto, Ontario. 5. , HBSc, BScPhm, PharmD, is a Clinical Pharmacist, Sunnybrook Health Sciences Centre, Toronto, Ontario. 6. , BScPhm, ACPR, MScPhm, is a Clinical Pharmacist, Sunnybrook Health Sciences Centre, Toronto, Ontario. 7. , BPharm, ACPR, is a Clinical Pharmacist, Sunny-brook Health Sciences Centre, Toronto, Ontario. 8. , BScPhm, ACPR, PharmD, is a Clinical Pharmacist, Sunny-brook Health Sciences Centre, Toronto, Ontario.
Abstract
BACKGROUND: Medication errors may occur more frequently at discharge, making discharge counselling a vital facet of medication reconciliation. Discharge counselling is a recognized patient safety initiative for which pharmacists have appropriate expertise, but data are lacking about the barriers to provision of this service to adult inpatients by pharmacists. OBJECTIVES: To determine the proportion of eligible patients who received discharge counselling, to quantify perceived barriers preventing pharmacists from performing discharge counselling, and to determine the relative frequency of barriers and associated time expenditures. METHODS: In this prospective study, 8 pharmacists working in general medicine, medical oncology, or nephrology wards of an acute care hospital completed a survey for each of the first 50 patients eligible for discharge counselling on their respective wards from June 2010 to February 2011. Patients discharged to another facility (rehabilitation, palliative care, or long-term care), those with hospital stay less than 48 h before discharge, and those whose medications were unchanged from hospital admission were ineligible. RESULTS: Discharge counselling was performed for 116 (29%) of the 403 eligible patients and involved a median preparation time of 25 min and median counselling time of 15 min per patient. At least one documented barrier to discharge counselling existed for 295 (73%) of the patients. Several barriers to discharge counselling occurred significantly more frequently on the general medicine and oncology wards than on the nephrology ward (p < 0.05). The most common barrier was failure to notify the pharmacist about impending patient discharge (130/313 [41%]). Time constraints existed for 130 (32%) of the patients, the most common related to clarification of prescriptions (96 [24%]), creation of a medication list (69 [17%]), and faxing of prescriptions (64 [16%]). CONCLUSION: This study generated objective data about the barriers to and time constraints associated with medication discharge counselling by pharmacists. These findings should raise awareness of the challenges faced by pharmacists in busy hospital positions and may support avenues of change for their hospital discharge counselling programs.
BACKGROUND: Medication errors may occur more frequently at discharge, making discharge counselling a vital facet of medication reconciliation. Discharge counselling is a recognized patient safety initiative for which pharmacists have appropriate expertise, but data are lacking about the barriers to provision of this service to adult inpatients by pharmacists. OBJECTIVES: To determine the proportion of eligible patients who received discharge counselling, to quantify perceived barriers preventing pharmacists from performing discharge counselling, and to determine the relative frequency of barriers and associated time expenditures. METHODS: In this prospective study, 8 pharmacists working in general medicine, medical oncology, or nephrology wards of an acute care hospital completed a survey for each of the first 50 patients eligible for discharge counselling on their respective wards from June 2010 to February 2011. Patients discharged to another facility (rehabilitation, palliative care, or long-term care), those with hospital stay less than 48 h before discharge, and those whose medications were unchanged from hospital admission were ineligible. RESULTS: Discharge counselling was performed for 116 (29%) of the 403 eligible patients and involved a median preparation time of 25 min and median counselling time of 15 min per patient. At least one documented barrier to discharge counselling existed for 295 (73%) of the patients. Several barriers to discharge counselling occurred significantly more frequently on the general medicine and oncology wards than on the nephrology ward (p < 0.05). The most common barrier was failure to notify the pharmacist about impending patient discharge (130/313 [41%]). Time constraints existed for 130 (32%) of the patients, the most common related to clarification of prescriptions (96 [24%]), creation of a medication list (69 [17%]), and faxing of prescriptions (64 [16%]). CONCLUSION: This study generated objective data about the barriers to and time constraints associated with medication discharge counselling by pharmacists. These findings should raise awareness of the challenges faced by pharmacists in busy hospital positions and may support avenues of change for their hospital discharge counselling programs.
Authors: Ulrika Gillespie; Anna Alassaad; Dan Henrohn; Hans Garmo; Margareta Hammarlund-Udenaes; Henrik Toss; Asa Kettis-Lindblad; Håkan Melhus; Claes Mörlin Journal: Arch Intern Med Date: 2009-05-11