[Communication about drug use in referrals, acute admissions and discharge letters]

It is critical to communicate properly about drug use across health care levels, to avoid adverse drug effects and medication errors. We have investigated communication about drug use between a hospital and the primary health care services through an assessment of referrals and discharge letters.

At Innlandet Hospital Trust Gjøvik, all elective referrals to the medical outpatient clinic and discharge letters from the medical department during two periods (in 2009) were copied and anonymised. The documents were searched for information about drug use and for completeness of that information. We also assessed whether admission letters for acute admissions to the medical department included a medication list.

92 (47%) of 194 of elective referrals, and 167 (91%) of 184 of discharge letters, contained complete information about drug use. In 61 (49%) of 125 of discharge letters that contained information about altered drug use, these changes were not discussed in the medication list. Among 196 acutely admitted patients who used drugs, medication lists were missing in 76 (39%). When the admitting doctor was a regular GP the lists were missing in 10 (16%) of 63 of admissions.

Proper communication about drug use seems to have low priority and patients are often admitted to and discharged from the hospital with insufficient information. Patients should have a paper version of their medication list until such information is available electronically.