MEDICATION RECONCILIATION AT DISCHARGE
Written discharge information including a Discharge Medication Report is mandatory when a patient is discharged from the hospital.
This information is structured, written for the patient, given to the patient and a copy is sent with the patient’s consent to the General Practitioner, community pharmacists or other healthcare professional of the choice of the patient on the day of discharge.
This information contains a Medication Report, a summary of relevant medication changes (due to allergies, resistencies, etc) actively performed during the hospital stay (what and why).
The Medication Report is the result of the reconciliation process between healthcare professionals.
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MEDICATION RECONCILIATION AT DISCHARGE
Contribution: National Board for Health and Welfare
Short description of the example
How did it start?
Actors involved?
Implementation timing?
Etc…
Can you explain why you consider this example as a good practice?
Do you have any evidence that this good practice reduced medication errors?
A research group (pharmacy, primary care, secondary care) identified problems with medication reconciliation when a patient is moved between different level of care (Midlöv 2005) and other pharmacotherapy problems in hospitals (Eriksson 1999). Based on this the process for a patients´ drug use at the hospital was described (from admission to discharge and to municipal care), problems in the process were identified and activities and tools to solve the problems were developed.
Since 2007 written discharge information including a Medication
Report is mandatory when a patient is discharged from the hospital.
This information is structured, written for the patient, given to the patient and a copy is sent to primary care and municipality care on the day of discharge. This information contains a
Medication Report, a summary of all medication changes actively performed during the hospital stay (what and why). Now the discharge information will be mandatory at all hospitals in the
Skane Region (9 hospitals, pop.1.3 Milj) and has also been spread to other parts of Sweden.
We have identified the problem as important, developed a tool and implemented the tool; first in small scale and now escalating. We performed a study to show the benefit (Midlöv
2008a+b) at a University hospital so it took approx 2 years. In
Sweden the model is now recommended for use and several counties have started the implementation with our help. When writing the Medication Report you have to state what has been changed and why. This improves the intellectual process and also documentation of drug therapy changes. It is also used as a simple tool in education on all levels to show improved quality.
Reduced error rates and contacts with health care by 50%
(Midlöv 2008a, 2008b)
A study of the implementation rate and errors will be used to further improve quality.
For hospitals; number of wards/total of wards that have routines and produce discharge summaries.
For wards; Frequency of correct medication report (what and reason why changed specified) and medication lists (what and indication for use specified). Total quality (readability, general
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MEDICATION RECONCILIATION AT DISCHARGE
What is the estimated cost of the implementation of the practice?
Name of the hospital,
Website link, Short description of the
hospital:- number of beds- type of activities- staff information etc). We have produced a checklist based on this. and performed two follow-up studies.
1 Quality control by a clinical pharmacist, feedback to the physician and corrections before patient discharge reduced the error rate by an additional 50% (Manuscript).
2. Follow up (University hospital, all 45 wards) on patients discharge during a 3 week period showed low frequency of producing discharge information and many errors in the
Medication Report and Medication Lists. The results have been benchmarked to each ward and activities will be performed for improvement, and the study will be repeated.
At Lund University hospital.
Meetings for implementation and follow up. 1 hour each physician(1*1000*40€)=40.000€
Research resources and students.
Lund University Hospital http://www.skane.se/default.aspx?id=81949
Acute, psychiatric and highly specialized care teaching hospital.
8.000 employees, 900 beds.
Budget 50 Billion €
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MEDICATION RECONCILIATION AT DISCHARGE
The following steps should be discussed between the national coordinator and the hospitals’ representatives:
Decision on where it will take place
Identify/Select one unit that will implement the medication report or
Identify/Select several units that will implement the medication report at the same time or
Identify/Select one unit as pilot and then later other units or
Implement in all hospital
Decision on who will be responsible of the implementation
Identify the team and/or the committee (or equivalent)
Definition of the timing
Describe the different steps of the implementation, considering that the WP4 implementation is from April 2009 to December 2009
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MEDICATION RECONCILIATION AT DISCHARGE
The responsible people identified by the hospitals’ representatives should ensure the following:
Collection of information on the implementation
To identify a person responsible for collecting, if different from the person in charge
Information and communication around the initiative
Organising information and communication activities around the initiatives at the different stages of the implementation:
For the staff involved in the discharge process
For other staff in the unit
For patients
For families and others
If feasible, for healthcare professionals of the choice of the patient outside the hospital
Development/implementation of the reconciliated or checked medication report
Using the example given by the good practice? or
Use existing elements in the hospital or
Create another one
Implementation of the medication reconciliation at discharge
Adapt/update the current hospital discharge policy (e.g. by including a copy of the good practice)
Apply the use of the medication r econciliation at discharge.
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MEDICATION RECONCILIATION AT DISCHARGE
Can you describe the situation or problem in medication safety you wanted to address by implementing the practice you have chosen?
Could you give some indication on the baseline situation in medication safety in your unit?
Can you describe the experiences during the implementation by answering the following questions?
Decision on where it will take place
Which procedure was followed to identify/select where it will take place?
Who decided that the hospital would participate in the implementation?
Was there any communication to identify and select? If yes, please specify.
Did units (and who in the unit) proposed themselves on a voluntary basis?
Who or which decision (and/or advisory) body was involved in the final
decision of selection?
Decision on who will be responsible for the implementation
Who (role and position in the organisation) and/or which committee has been in charge at all steps of implementation?
Defining the time
Was the time appropriate, i.e., was there enough time to put the practice into place? If not, please specify.
Development/implementation of the reconciliated or checked medication report
Have you use the example given by the good practice?
Have you use existing elements in the hospital? If yes, please specify.
Have you created your own? If yes, why? What was needed to adapt?
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MEDICATION RECONCILIATION AT DISCHARGE
Information and communication on the process
What have been the specific actions to reach each target group? Please specify.
For the staff involved in the discharge process
For other staff in the unit
For patients
For families and others
If feasible, for healthcare professionals of the choice of the patient outside the hospital
Implementation of the medication report
Documenting the implementation process using the grid for data collection
General perception
Can you describe the outcome situation after the implementation period?
On the basis of your experience do you consider that this good practice would be transferable in other units in the hospital? In other hospitals in your country?
Collection of information on the implementation
Have you been using evaluation tools already available in the hospital to evaluate the impact (even subjective) of the initiative?
If yes, have you notice any impact?
If not, have you gathered elements on perception?
From the staff involved in the discharge process
From other staff in the unit
For families and others
If feasible, for healthcare professionals of the choice of the patient outside the hospital
In case the initiative was done only in one (some) unit(s), will the hospital expand the initiative to other units? If not, why?
Evaluation of the impact
How many patients received the medication out of the total number of discharged patients?
Was the list sufficiently accurate?
Was the initiative perceived by the people involved as bringing better value for the unit/hospital/ patient?
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