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Title: Pharmacist-Physician Collaboration to Improve the Accuracy of Medication Information in Electronic Medical Discharge Summaries: Effectiveness and Sustainability.
Austin Authors: Elliott, Rohan A ;Tan, Yixin;Chan, Vincent ;Richardson, Belinda ;Tanner, Francine E ;Dorevitch, Michael I 
Affiliation: Centre for Medicine Use and Safety, Monash University, Parkville, VIC 3052, Australia
Pharmacy Department, Austin Health, Heidelberg, Victoria, Australia
School of Health and Biomedical Sciences, RMIT University, Bundoora, VIC 3083, Australia
Pharmacy Department, Waitemata District Health Board, Auckland 0620, New Zealand
Department of Aged Care Services, Austin Health, Heidelberg, Victoria, Australia
Issue Date: 30-Dec-2019
Date: 2019-12-30
Publication information: Pharmacy (Basel, Switzerland) 2019; 8(1)
Abstract: Inaccurate or missing medication information in medical discharge summaries is a widespread and intractable problem. This study evaluated the effectiveness and sustainability of an intervention in which ward-based hospital pharmacists reviewed, contributed and verified medication information in electronic discharge summaries (EDSs) in collaboration with physicians. Retrospective audits of randomly selected EDSs were conducted on seven wards at a major public hospital before and after implementation of the intervention and repeated two years later on four wards where the intervention was incorporated into usual pharmacist care. EDSs for 265 patients (prescribed a median of nine discharge medications) were assessed across the three time points. Pharmacists verified the EDSs for 47% patients in the first post-intervention audit and 68% patients in the second post-intervention audit. Following the intervention, the proportion of patients with one or more clinically significant discharge medication list discrepancy fell from 40/93 (43%) to 14/92 (15%), p < 0.001. The proportion of clinically significant medication changes stated in the EDSs increased from 222/417 (53%) to 296/366 (81%), p < 0.001, and the proportion both stated and explained increased from 206/417 (49%) to 245/366 (67%), p < 0.001. Significant improvements were still evident after two years. Pharmacists spent a median of 5 (range 2-16) minutes per patient contributing to EDSs. Logistics, timing and pharmacist workload were barriers to delivering the intervention. Additional staff resources is needed to enable pharmacists to consistently deliver this effective intervention.
DOI: 10.3390/pharmacy8010002
ORCID: 0000-0002-7750-9724
Journal: Pharmacy (Basel, Switzerland)
PubMed URL: 31905902
Type: Journal Article
Subjects: care transition
patient discharge summaries
patient transfer
Appears in Collections:Journal articles

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