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International Journal of Clinical Pharmacy

, Volume 39, Issue 6, pp 1331–1337 | Cite as

Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records

  • Beate Hennie GarciaEmail author
  • Berit Svendsen Djønne
  • Frode Skjold
  • Ellen Marie Mellingen
  • Trine Iversen Aag
Research Article
First Online:

Abstract

Background Low quality of medication information in discharge summaries from hospitals may jeopardize optimal therapy and put the patient at risk for medication errors and adverse drug events. Objective To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Setting Helgelandssykehuset Mo i Rana, a rural hospital in central Norway. Method For each month in 2013, we randomly selected 60 discharge summaries from the Department of Medicine and Surgery (totally 720) and evaluated the medication information using eight Norwegian quality criteria. Main outcome measure Mean score per discharge summary ranging from 0 (lowest quality) to 16 (highest quality). Results Mean score per discharge summary was 7.4 (SD 2.8; range 0–14), significantly higher when evaluating medications used regularly compared to mediations used as needed (7.80 vs. 6.52; p < 0.001). Lowest score was achieved for quality criteria concerning generic names, indications for medication use, reasons why changes had been made and information about the source for information. Factors associated with increased quality scores are increasing numbers of medications and male patients. Increasing age seemed to be associated with a reduced score, while type of department was not associated with the quality. Conclusion In discharge summaries from 2013, we identified a low quality of medication information in accordance with the Norwegian quality criteria. Actions for improvement are necessary and follow-up studies to monitor quality are needed.

Keywords

Clinical audit Communication Hospital Medication Systems Norway Patient discharge summary Quality of health care 
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Notes

Acknowledgements

This study has been performed as a master study in pharmacy. We are grateful to all staff at Helgelandssykehuset Mo i Rana, Hospital Pharmacy of North Norway Trust and UiT the Arctic University of Norway that have contributed to carrying out this study, both by identification of discharge summaries, data extraction and professional discussions.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Conflicts of interest

The authors declared that they have no conflict of interest.

References

  1. 1.
    Wimsett J, Harper A, Jones P. Review article: components of a good quality discharge summary: a systematic review. Emerg Med Australas. 2014;26(5):430–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Kattel S, Manning DM, Erwin PJ, Wood H, Kashiwagi DT, Murad MH. Information transfer at hospital discharge: a systematic review. J Patient Saf. 2016.Google Scholar
  3. 3.
    Unnewehr M, Schaaf B, Marev R, Fitch J, Friederichs H. Optimizing the quality of hospital discharge summaries—a systematic review and practical tools. Postgrad Med. 2015;127(6):630–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831–41.CrossRefPubMedGoogle Scholar
  5. 5.
    Salim Al-Damluji M, Dzara K, Hodshon B, Punnanithinont N, Krumholz HM, Chaudhry SI, et al. Association of discharge summary quality with readmission risk for patients hospitalized with heart failure exacerbation. Circ Cardiovasc Qual Outcomes. 2015;8(1):109–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Glintborg B, Andersen SE, Dalhoff K. Insufficient communication about medication use at the interface between hospital and primary care. Qual Saf Health Care. 2007;16(1):34–9.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Ebbesen J, Buajordet I, Erikssen J, Brors O, Hilberg T, Svaar H, et al. Drug-related deaths in a department of internal medicine. Arch Intern Med. 2001;161(19):2317–23.CrossRefPubMedGoogle Scholar
  8. 8.
    World Health Organization. Patient safety—data and statistics [cited 2017 08.06]. Available from: http://www.euro.who.int/en/health-topics/Health-systems/patient-safety/data-and-statistics.
  9. 9.
    European Medicines Agency. Medication errors—follow-up actions from workshop 2014 [cited 2017 08.06]. Available from: http://www.ema.europa.eu/docs/en_GB/document_library/Presentation/2014/04/WC500165789.pdf.
  10. 10.
    Torjesen I. Medication errors cost the NHS up to £2.5bn a year 2014 [cited 2017 08.06]. Available from: http://www.pharmaceutical-journal.com/news-and-analysis/medication-errors-cost-the-nhs-up-to-25bn-a-year/20066893.article.
  11. 11.
    Hammad EA, Wright DJ, Walton C, Nunney I, Bhattacharya D. Adherence to UK national guidance for discharge information: an audit in primary care. Br J Clin Pharmacol. 2014;78(6):1453–64.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Frydenberg K, Brekke M. Communication about drug use in referrals, acute admissions and discharge letters. Tidsskr Nor Laegeforen. 2011;131(9–10):942–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Statens Helsetilsyn. Oppsummering av landsomfattende tilsyn i 2015 med samhandling om utskrivning av pasienter fra spesialisthelsetjenesten til kommunen 2016 [cited 2017 08.06]. Available from: https://www.helsetilsynet.no/Tilsyn/Landsomfattende-tilsyn/.
  14. 14.
    Pasientsikkerhetsprogrammet.no. Tiltakspakke for legemiddelsamstemming (Eng: Action plan for medication reconciliation) 2011 [cited 2017 08.06]. Available from: http://www.pasientsikkerhetsprogrammet.no/om-oss/innsatsområder/_attachment/2014?_download=false&_ts=14999abaada.
  15. 15.
    Helgelandssykehuset HF - i Sandnessjøen, Brønnøysund, Mo i Rana og Mosjøen [cited 2017 08.06]. Available from: https://helgelandssykehuset.no/om-oss.
  16. 16.
    Research randomizer [cited 2016 12-06]. Available from: https://www.randomizer.org/.
  17. 17.
    Robson C. Real world research: a resource for social scientists and practitioner-researchers. 2nd ed. Malden: Blackwell Publishing; 2002.Google Scholar
  18. 18.
    Grimes TC, Duggan CA, Delaney TP, Graham IM, Conlon KC, Deasy E, et al. Medication details documented on hospital discharge: cross-sectional observational study of factors associated with medication non-reconciliation. Br J Clin Pharmacol. 2011;71(3):449–57.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Dyrkorn R, Espnes KA. Safe drug therapy–what can be done? Tidsskr Nor Laegeforen. 2011;131(5):451.CrossRefPubMedGoogle Scholar
  20. 20.
    Midlov P, Bahrani L, Seyfali M, Hoglund P, Rickhag E, Eriksson T. The effect of medication reconciliation in elderly patients at hospital discharge. Int J Clin Pharm. 2012;34(1):113–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Bergkvist A, Midlov P, Hoglund P, Larsson L, Bondesson A, Eriksson T. Improved quality in the hospital discharge summary reduces medication errors—LIMM: landskrona integrated medicines management. Eur J Clin Pharmacol. 2009;65(10):1037–46.CrossRefPubMedGoogle Scholar
  22. 22.
    Lau HS, Florax C, Porsius AJ, De Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol. 2000;49(6):597–603.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Aag T, Garcia BH, Viktil KK. Should nurses or clinical pharmacists perform medication reconciliation? A randomized controlled trial. Eur J Clin Pharmacol. 2014;70(11):1325–32.CrossRefPubMedGoogle Scholar
  24. 24.
    Pasientsikkerhetsprogrammet.no. Felles retningslinje for legemiddelsamstemming i Helse Nord RHF (Eng: Common guidelines for medication reconciliation in the Northern Norway Regional Health Authority) 2015 [cited 2017 08.06]. Available from: http://www.pasientsikkerhetsprogrammet.no/aktuelt/nyheter/felles-retningslinjer-for-legemiddelsamstemming-i-helse-nord-rhf.
  25. 25.
    Tan B, Mulo B, Skinner M. Transition from hospital to primary care: an audit of discharge summary—medication changes and follow-up expectations. Intern Med J. 2014;44(11):1124–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Kvaerner KJ, Tjerbo T, Botten G, Aasland OG. Hospital discharge information as a communication tool. Tidsskr Nor Laegeforen. 2005;125(20):2815–7.PubMedGoogle Scholar
  27. 27.
    Kampman MT, Brox NM, Bugge E, Bjornstad C. Generic prescription of drugs in hospitals. Tidsskr Nor Laegeforen. 2014;134(6):599–600.CrossRefPubMedGoogle Scholar
  28. 28.
    Ziaeian B, Araujo KL, Van Ness PH, Horwitz LI. Medication reconciliation accuracy and patient understanding of intended medication changes on hospital discharge. J Gen Intern Med. 2012;27(11):1513–20.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Pasientsikkerhetsprogrammet.no. Revidert tiltakspakke for samstemming av legemidler (Eng: Revised action plan for medication reconciliation) 2015 [cited 2017 06.08]. Available from: http://www.pasientsikkerhetsprogrammet.no/om-oss/innsatsområder/_attachment/3398?_download=false&_ts=1515dbc6254.

Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  1. 1.Department of Pharmacy, Faculty of Health SciencesUiT the Arctic University of NorwayTromsøNorway
  2. 2.Hospital Pharmacy of North Norway Trust (Sykehusapotek Nord HF)TromsøNorway
  3. 3.Helgelandssykehuset Mo i RanaMo i RanaNorway

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