Emergency Department to Residential Aged Care Facility continuum of care: ensuring patients do not miss medication doses

Abstract

Aim: Previous studies have shown that when patients are discharged from hospital to residential aged care facilities (RACFs) with interim medication charts (IMCs), fewer medication doses are delayed or missed. Emergency department (ED) patients have been excluded from these studies. For over a decade, Austin Hospital ED has provided their RACF patients with an IMC, but the impact of this process has not previously been described. This study aimed to describe the medication-related transition of care following transfer from ED to RACF.

Methods: Patients discharged from ED to a RACF, with one or more medication regimen changes made in ED, were included in this observational study. Data were collected from hospital electronic medical records and telephone interviews with RACF staff 2-7 days after patients left ED.

Results: RACF nurses of 100 patients (mean age 82.7 ± 8.9 years, median of 10 pre-admission medications) were interviewed. Seventy (70%) and 20 (20%) of patients were discharged with pharmacist-prepared or doctor-prepared IMCs, respectively. Nine (9%) patients had one or more missed or significantly delayed medication doses in the 24 hours following ED discharge. RACF staff were very supportive of IMCs being provided; they could not always be used for documentation in RACFs that have electronic medical records, but were useful to clearly communicate changes to made to medication regimens in ED.

Conclusion: Achieving a smooth medication-related continuum of care for patients transferring from ED to RACF is complex. Provision of IMC by ED staff is feasible and valued by RACF staff.

Impact: Ensuring patients receive their new medication regimen following transfer to their aged care facility, when changes are made in the emergency department is complicated. Emergency department doctors and pharmacists should continue to provide interim medication charts so that dose changes are clear and can be documented and to avoid missed doses.