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Title: Improving communication of medication changes using a pharmacist-prepared discharge medication management summary
Austin Authors: Ooi, Choon Ean;Rofe, Olivia;Vienet, Michelle;Elliott, Rohan A 
Affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
Eastern Health, Box Hill, Victoria, Australia
Austin Health, Heidelberg, Victoria, Australia
Issue Date: Apr-2017 2017-03-11
Publication information: International Journal of Clinical Pharmacy 2017; 39(2): 394-402
Abstract: Background Discontinuity of care between hospital and primary care is often due to poor information transfer. Medication information in medical discharge summaries (DS) is often incomplete or incorrect. The effectiveness and feasibility of hospital pharmacists communicating medication information, including changes made in the hospital, is not clearly defined. Objective To explore the impact of a pharmacist-prepared Discharge Medication Management Summary (DMMS) on the accuracy of information about medication changes provided to patients’ general practitioners (GPs). Setting Two medical wards at a major metropolitan hospital in Australia. Method An intervention was developed in which ward pharmacists communicated medication change information to GPs using the DMMS. Retrospective audits were conducted at baseline and after implementation of the DMMS to compare the accuracy of information provided by doctors and pharmacists. GPs’ satisfaction with the DMMS was assessed through a faxed survey. Main outcome measure Accuracy of medication change information communicated to GPs; GP satisfaction and feasibility of a pharmacist-prepared DMMS. Results At baseline, 263/573 (45.9%) medication changes were documented by doctors in the DS. In the post-intervention audit, more medication changes were documented in the pharmacist-prepared DMMS compared to the doctor-prepared DS (72.8% vs. 31.5%; p < 0.001). Most GPs (73.3%) were satisfied with the information provided and wanted to receive the DMMS in the future. Completing the DMMS took pharmacists an average of 11.7 minutes. Conclusion The accuracy of medication information transferred upon discharge can be improved by expanding the role of hospital pharmacists to include documenting medication changes.
DOI: 10.1007/s11096-017-0435-5
PubMed URL:
Type: Journal Article
Subjects: Australia
Continuity of patient care
Medication changes
Medication management
Patient transfer
Appears in Collections:Journal articles

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