Improving communication of medication changes using a pharmacist-prepared discharge medication management summary

Area of Science:

• Pharmacy Practice
• Patient Safety
• Health Information Transfer

Background:

• Discontinuity of care between hospital and primary care is a significant issue, often stemming from inadequate information transfer.
• Medication information within medical discharge summaries (DS) is frequently incomplete or inaccurate, posing risks to patient safety.
• The role and effectiveness of hospital pharmacists in communicating medication changes to primary care providers remain underexplored.

Purpose of the Study:

• To evaluate the impact of a pharmacist-developed Discharge Medication Management Summary (DMMS) on the accuracy of medication change information conveyed to general practitioners (GPs).
• To assess the feasibility and satisfaction levels associated with using DMMS by both pharmacists and GPs.

Main Methods:

• An intervention was implemented where ward pharmacists utilized DMMS to communicate medication changes to GPs.
• Retrospective audits were conducted pre- and post-intervention to compare the accuracy of medication change documentation in DS versus DMMS.
• GP satisfaction was measured via a survey to gauge their perception of the DMMS.

Main Results:

• The pharmacist-prepared DMMS documented significantly more medication changes (72.8%) compared to doctor-prepared DS (31.5%) post-intervention (p < 0.001).
• A majority of GPs (73.3%) expressed satisfaction with the DMMS and indicated a desire for its continued use.
• The average time for pharmacists to complete a DMMS was 11.7 minutes.

Conclusions:

• Expanding the role of hospital pharmacists to include documenting medication changes in a structured summary (DMMS) can substantially improve the accuracy of medication information transfer at hospital discharge.
• The DMMS intervention demonstrates feasibility and effectiveness in enhancing communication between hospital and primary care, ultimately benefiting patient safety.