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

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

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.

    Article  PubMed  Google 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.

  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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    CAS  Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Dyrkorn R, Espnes KA. Safe drug therapy–what can be done? Tidsskr Nor Laegeforen. 2011;131(5):451.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    CAS  Article  PubMed  PubMed Central  Google 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.

    CAS  Article  PubMed  Google 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.

    CAS  Article  PubMed  Google 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.

    PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

Download references

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.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Beate Hennie Garcia.

Ethics declarations

Conflicts of interest

The authors declared that they have no conflict of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Garcia, B.H., Djønne, B.S., Skjold, F. et al. Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records. Int J Clin Pharm 39, 1331–1337 (2017). https://doi.org/10.1007/s11096-017-0556-x

Download citation

Keywords

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