Anne Holbrook1, Heather Bannerman2, Amna Ahmed3, Michael Georgy4, J Tiger Liu5, Sue Troyan6, Alice Watt7. 1. , MD, PharmD, MSc, FRCPC, is with the Division of Clinical Pharmacology & Toxicology and the Department of Medicine, McMaster University, Hamilton, Ontario. 2. , MD, PharmD, BScPhm, is with the Internal Medicine Residency Program, Department of Medicine, McMaster University, Hamilton, Ontario. 3. , MD, is with the Department of Medicine, McMaster University, Hamilton, Ontario. 4. , MBBCh, is a student currently affiliated with the Royal College of Surgeons in Ireland, Dublin, Ireland. 5. , MSc, was, at the time of this study, a student with the eHealth Master's Program, McMaster University, Hamilton, Ontario. 6. , BA, is with the Division of Clinical Pharmacology & Toxicology, St Joseph's Hospital Hamilton, Hamilton, Ontario. 7. , BSc(Pharm), RPh, is with the Institute for Safe Medication Practices Canada, Toronto, Ontario.
Abstract
BACKGROUND: 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. OBJECTIVES: To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals. METHODS: 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. RESULTS: 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. CONCLUSIONS: The modified audit tool was useful for identifying gaps in the quality of discharge MedRec. 2019 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
BACKGROUND: 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. OBJECTIVES: To evaluate and optimize a new discharge MedRec quality audit tool and to use it at 3 urban teaching hospitals. METHODS: 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. RESULTS: 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. CONCLUSIONS: The modified audit tool was useful for identifying gaps in the quality of discharge MedRec. 2019 Canadian Society of Hospital Pharmacists. All content in the Canadian Journal of Hospital Pharmacy is copyrighted by the Canadian Society of Hospital Pharmacy. In submitting their manuscripts, the authors transfer, assign, and otherwise convey all copyright ownership to CSHP.
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