Applying Quality Improvement methods to address gaps in medicines reconciliation at transfers of care from an acute UK hospital
File(s)BMJ Open-2016-Marvin-.pdf (1.66 MB) Marvin et al 2016 accepted.pdf (2.56 MB)
Published version
Accepted version
Author(s)
Type
Journal Article
Abstract
Objectives: Reliable reconciliation of medicines at admission and discharge
from hospital is key to reducing unintentional prescribing discrepancies at
transitions of health care. We introduced a team approach to the reconciliation
process at an acute hospital with the aim of improving the provision of
information and documentation of reliable medication lists to enable clear,
timely communications on discharge.
Setting: An acute 400 bedded teaching hospital in London UK.
Participants: The effects of change were measured in a simple random
sample of ten adult patients a week on the Acute Admissions Unit over 18
months.
Interventions: Quality Improvement methods were used throughout.
Interventions included education and training of staff involved at ward level
and in the pharmacy department, introduction of medication documentation
templates for electronic prescribing and for communicating information on
medicines in discharge summaries co-designed with patient representatives.
Results: Statistical Process Control analysis showed reliable documentation
(complete, verified and intentional changes clarified) of current medication on
49.2% of patients’ discharge summaries. This appears to have improved (to
85.2%) according to a post-study audit the year after the project end.
Pharmacist involvement in discharge reconciliation significantly increased,
and improvements in the numbers of medicines prescribed in error or omitted
from the discharge prescription are demonstrated. Variation in weekly
measures is seen throughout but particularly at periods of changeover of new
doctors and introduction of new systems.
Conclusion: New processes led to a sustained increase in reconciled
medications and thereby an improvement in the number of patients
discharged from hospital with unintentional discrepancies (errors or
omissions) on their discharge prescription.
The initiatives were pharmacist-led but involved close working and shared
understanding about roles and responsibilities between doctors, nurses,
therapists, patients and their carers.
from hospital is key to reducing unintentional prescribing discrepancies at
transitions of health care. We introduced a team approach to the reconciliation
process at an acute hospital with the aim of improving the provision of
information and documentation of reliable medication lists to enable clear,
timely communications on discharge.
Setting: An acute 400 bedded teaching hospital in London UK.
Participants: The effects of change were measured in a simple random
sample of ten adult patients a week on the Acute Admissions Unit over 18
months.
Interventions: Quality Improvement methods were used throughout.
Interventions included education and training of staff involved at ward level
and in the pharmacy department, introduction of medication documentation
templates for electronic prescribing and for communicating information on
medicines in discharge summaries co-designed with patient representatives.
Results: Statistical Process Control analysis showed reliable documentation
(complete, verified and intentional changes clarified) of current medication on
49.2% of patients’ discharge summaries. This appears to have improved (to
85.2%) according to a post-study audit the year after the project end.
Pharmacist involvement in discharge reconciliation significantly increased,
and improvements in the numbers of medicines prescribed in error or omitted
from the discharge prescription are demonstrated. Variation in weekly
measures is seen throughout but particularly at periods of changeover of new
doctors and introduction of new systems.
Conclusion: New processes led to a sustained increase in reconciled
medications and thereby an improvement in the number of patients
discharged from hospital with unintentional discrepancies (errors or
omissions) on their discharge prescription.
The initiatives were pharmacist-led but involved close working and shared
understanding about roles and responsibilities between doctors, nurses,
therapists, patients and their carers.
Date Issued
2016-06-10
Date Acceptance
2016-04-27
Citation
BMJ Open, 2016, 6
ISSN
2044-6055
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Open
Volume
6
Copyright Statement
This is an Open Access article distributed in accordance with
the terms of the Creative Commons Attribution (CC BY 4.0) license, which
permits others to distribute, remix, adapt and build upon this work, for
commercial use, provided the original work is properly cited. See: http://
creativecommons.org/licenses/by/4.0/
the terms of the Creative Commons Attribution (CC BY 4.0) license, which
permits others to distribute, remix, adapt and build upon this work, for
commercial use, provided the original work is properly cited. See: http://
creativecommons.org/licenses/by/4.0/
License URL
Sponsor
National Institute for Health Research
Grant Number
N/A
Subjects
Medication reconciliation
Patient safety
hospital pharmacist
quality improvement
Publication Status
Published
Article Number
e010230