Abstract
Background
Medication discrepancies can occur in transitions of care because of a lack of communication between hospitals and community pharmacies. These discrepancies can lead to preventable adverse drug events (ADEs).
Aim
To investigate the effect of electronic transmission of the basic discharge medication report on unintentional medication discrepancies observed between this report and the 28-day post-discharge status in the community pharmacy.
Method
The study took place in a Dutch teaching hospital and 8 community pharmacies. A quality improvement study with a nonrandomized, historically controlled intervention design was performed. The intervention consisted of the electronic transmission of a basic discharge medication report to the community pharmacies. Unintentional medication discrepancies were identified by comparing the basic discharge medication report to the 28-day post-discharge medication record in community pharmacies. The main outcome measure was the proportion of drugs with one or more unintentional discrepancies compared between the historical control group and intervention group, using the chi-square test. Secondary outcome measure was the proportion of patients with one or more unintentional discrepancies.
Results
The participants used a total of 1078 drugs in the control group and 862 in the intervention group. The intervention significantly reduced the proportion of drugs with an unintentional discrepancy from 230 out of 1078 in the control group (21.3%) to 149 out of 862 drugs in the intervention group (17.3%; p = 0.025). At patient level, a non-significant increase was seen (62.4–78.8%; p = 0.41).
Conclusion
The electronic transmission of the basic discharge medication report reduced the proportion of drugs with an unintentional discrepancy after discharge, but not the proportion of patients.
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References
Mueller SK, Sponsler KC, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012;172(14):1057–69. https://doi.org/10.1001/archinternmed.2012.2246.
Urban R, Paloumpi E, Rana N, et al. Communicating medication changes to community pharmacy post-discharge: the good, the bad, and the improvements. Int J Clin Pharm. 2013;35(5):813–20. https://doi.org/10.1007/s11096-013-9813-9.
Perry TD, Nye AM, Johnson SW. Medication discrepancy rates among Medicaid recipients at hospital discharge. J Am Pharm Assoc. 2017;57(4):488–92. https://doi.org/10.1016/j.japh.2017.03.010.
Herrero-Herrero JI, García-Aparicio J. Medication discrepancies at discharge from an internal medicine service. Eur J Intern Med. 2011;22(1):43–8. https://doi.org/10.1016/j.ejim.2010.10.003.
Alqenae FA, Steinke D, Keers RN. Prevalence and nature of medication errors and medication-related harm following discharge from hospital to community settings: a systematic review. Drug Saf. 2020;43(6):517–37. https://doi.org/10.1007/s40264-020-00918-3.
Ensing HT, Koster ES, van Berkel PI, et al. Problems with continuity of care identified by community pharmacists post-discharge. J Clin Pharm Ther. 2017;42(2):170–7. https://doi.org/10.1111/jcpt.12488.
Forster AJ, Clark HD, Menard A, et al. Adverse events among medical patients after discharge from hospital. CMAJ. 2004;170(3):345–9.
Al-Hashar A, Al-Zakwani I, Eriksson T, et al. Impact of medication reconciliation and review and counselling, on adverse drug events and healthcare resource use. Int J Clin Pharm. 2018;40(5):1154–64. https://doi.org/10.1007/s11096-018-0650-8.
Coleman EA, Smith JD, Raha D, et al. Posthospital medication discrepancies: prevalence and contributing factors. Arch Intern Med. 2005;165(16):1842–7. https://doi.org/10.1001/archinte.165.16.1842.
Amarasingham R, Plantinga L, Diener-West M, et al. Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch Intern Med. 2009;169(2):108–14. https://doi.org/10.1001/archinternmed.2008.520.
Farley TM, Shelsky C, Powell S, et al. Effect of clinical pharmacist intervention on medication discrepancies following hospital discharge. Int J Clin Pharm. 2014;36(2):430–7. https://doi.org/10.1007/s11096-014-9917-x.
Hockly M, Williams S, Allen M. Transfer of care - a randomised control trial investigating the effect of sending the details of patients’ discharge medication to their community pharmacist on discharge from hospital. Int J Pharm Pract. 2018;26(2):174–82. https://doi.org/10.1111/ijpp.12364.
Eggink RN, Lenderink AW, Widdershoven JW, et al. The effect of a clinical pharmacist discharge service on medication discrepancies in patients with heart failure. Pharm World Sci. 2010;32(6):759–66. https://doi.org/10.1007/s11096-010-9433-6.
De Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie. Richtlijn Overdracht van medicatiegegevens in de keten. 2018/2019. 2019. https://www.knmp.nl/richtlijnen/overdracht-van-medicatiegegevens-de-keten. Accessed 28 Dec 2022.
Buurma H, Bouvy ML, De Smet PA, et al. Prevalence and determinants of pharmacy shopping behaviour. J Clin Pharm Ther. 2008;33(1):17–23. https://doi.org/10.1111/j.1365-2710.2008.00878.x.
Uitvlugt EB, van den Bemt BJF, Chung WL, et al. Validity of a nationwide medication record system in the Netherlands. Int J Clin Pharm. 2019;41(3):687–90. https://doi.org/10.1007/s11096-019-00839-x.
World Health Organization. Medication Safety in transitions of care. 2019. https://www.who.int/publications/i/item/WHO-UHC-SDS-2019.9. Accessed 28 Dec 2022.
Almanasreh E, Moles R, Chen TF. The medication discrepancy taxonomy (MedTax): The development and validation of a classification system for medication discrepancies identified through medication reconciliation. Res Social Adm Pharm. 2020;16(2):142–8. https://doi.org/10.1016/j.sapharm.2019.04.005.
Claeys C, Nève J, Tulkens PM, et al. Content validity and inter-rater reliability of an instrument to characterize unintentional medication discrepancies. Drugs Aging. 2012;29(7):577–91. https://doi.org/10.1007/BF03262275.
Smith JD, Coleman EA, Min SJ. A new tool for identifying discrepancies in postacute medications for community-dwelling older adults. Am J Geriatr Pharmacother. 2004;2(2):141–7. https://doi.org/10.1016/s1543-5946(04)90019-0.
Geurts MM, van der Flier M, de Vries-Bots AM, et al. Medication reconciliation to solve discrepancies in discharge documents after discharge from the hospital. Int J Clin Pharm. 2013;35(4):600–7. https://doi.org/10.1007/s11096-013-9776-x.
Breuker C, Macioce V, Mura T, et al. Medication errors at hospital admission and discharge in type 1 and 2 diabetes. Diabet Med. 2017;34(12):1742–6. https://doi.org/10.1111/dme.13531.
Duggan C, Feldman R, Hough J, et al. Reducing adverse prescribing discrepancies following hospital discharge. Int J Pharm Pract. 1998;6(2):77–82. https://doi.org/10.1111/j.2042-7174.1998.tb00920.x.
Fleiss JL. Statistical methods for rates and proportions. 3rd ed. Levin B, Paik MC, editors: Hoboken, Wiley; 2003.
Van Der Luit CD, De Jong IR, Ebbens MM, et al. Frequency of occurrence of medication discrepancies and associated risk factors in cases of acute hospital admission. Pharm Pract (Granada). 2018;16(4):1301. https://doi.org/10.18549/PharmPract.2018.04.1301.
Acknowledgements
We would like to thank the pharmacists of the community pharmacies de Heemsteedse Apotheek, Apotheek Roodmus, Apotheek ‘t Sorghbosch, Centraal Apotheek Haarlem, Apotheek Schoterbos, Schalkwijk Apotheek, Apotheek Molenwijk, and Boerhaavewijk Apotheek for their participation.
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Koot, C., Rook, M., Pols, P.A.M. et al. A quality improvement study on the effect of electronic transmission of a basic discharge medication report on medication discrepancies in patients discharged from the hospital. Int J Clin Pharm 46, 131–140 (2024). https://doi.org/10.1007/s11096-023-01650-5
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DOI: https://doi.org/10.1007/s11096-023-01650-5