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Improved quality in the hospital discharge summary reduces medication errors—LIMM: Landskrona Integrated Medicines Management

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care.

Methods

This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home.

Results

By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001).

Conclusion

Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.

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References

  1. Kwan Y, Fernandes OA, Nagge JJ, Wong GG, Huh JH, Hurn DA, Pond GR, Bajcar JM (2007) Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med 167(10):1034–1040. doi:10.1001/archinte.167.10.1034

    Article  PubMed  Google Scholar 

  2. Lisby M, Nielsen LP, Mainz J (2005) Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care 17(1):15–22. doi:10.1093/intqhc/mzi015

    Article  PubMed  Google Scholar 

  3. Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE (2005) Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ 173(5):510–515. doi:10.1503/cmaj.045311

    PubMed  Google Scholar 

  4. Dean B, Schachter M, Vincent C, Barber N (2002) Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care 11(4):340–344

    Article  PubMed  CAS  Google Scholar 

  5. Runciman WB, Roughead EE, Semple SJ, Adams RJ (2003) Adverse drug events and medication errors in Australia. Int J Qual Health Care 15(Suppl 1):i49–59

    Article  PubMed  Google Scholar 

  6. Wilson S, Ruscoe W, Chapman M, Miller R (2001) General practitioner-hospital communications: a review of discharge summaries. J Qual Clin Pract 21(4):104–108

    Article  PubMed  CAS  Google Scholar 

  7. Gleason KM, Groszek JM, Sullivan C, Rooney D, Barnard C, Noskin GA (2004) Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients. Am J Health Syst Pharm 61(16):1689–1695

    PubMed  Google Scholar 

  8. Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H (2004) Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci 26(6):353–360

    PubMed  Google Scholar 

  9. Cua YM, Kripalani S (2008) Medication use in the transition from hospital to home. Ann Acad Med Singapore 37(2):136–136

    PubMed  Google Scholar 

  10. Poole DL, Chainakul JN, Pearson M, Graham L (2006) Medication reconciliation: a necessity in promoting a safe hospital discharge. J Healthc Qual 28(3):12–19

    PubMed  Google Scholar 

  11. Institute for Healthcare Improvement (2008) Medication reconciliation review. http://www.ihi.org/IHI/Topics/PatientSafety/MedicationSystems/Tools/Medication+Reconciliation+Review.htm. Accessed 28th August 2008

  12. Dudas V, Bookwalter T, Kerr KM, Pantilat SZ (2001) The impact of follow-up telephone calls to patients after hospitalization. Am J Med 111: 26S-30S doi: 10.1016/S0002-9343(01)00966-4

    Article  PubMed  CAS  Google Scholar 

  13. Duggan C, Feldman R, Hough J, Bates I (1998) Reducing adverse prescribing discrepancies following hospital discharge. Int J Pharm Pract 6:77–82

    Google Scholar 

  14. Paquette-Lamontagne N, McLean WM, Besse L, Cusson J (2001) Evaluation of a new integrated discharge prescription form. Ann Pharmacother 35(7–8):953–958

    Article  PubMed  CAS  Google Scholar 

  15. Bondesson A, Hellström L, Eriksson T, Höglund P (2009) A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data. J Eval Clin Pract (in press)

  16. Council of Europe (2006) Creation of a better medication safety culture in Europe: building up a safer medication practice. Expert group on safe medication practices. http://wwwcoeint/t/e/social_cohesion/soc-sp/Medication%20Safety%20culture%20report%20E.pdf. Accessed 8 Apr 2009

  17. Jerlvall L, Pehrsson T (2008) IT support in the counties (in Swedish). Swedish Association of Local Authorities and Regions, Stockholm

  18. Midlov P, Bergkvist A, Bondesson A, Eriksson T, Hoglund P (2005) Medication errors when transferring elderly patients between primary health care and hospital care. Pharm World Sci 27(2):116–120

    Article  PubMed  Google Scholar 

  19. Midlov P, Holmdahl L, Eriksson T, Bergkvist A, Ljungberg B, Widner H, Nerbrand C, Hoglund P (2008) Medication report reduces number of medication errors when elderly patients are discharged from hospital. Pharm World Sci 30(1):92–98. doi:10.1007/s11096-007-9149-4

    Article  PubMed  Google Scholar 

  20. Midlov P, Deierborg E, Holmdahl L, Hoglund P, Eriksson T (2008) Clinical outcomes from the use of medication report when elderly patients are discharged from hospital. Pharm World Sci 30:840–845. doi:10.1007/s11096-008-9236-1

    Google Scholar 

  21. Bergkvist A, Midlov P, Hoglund P, Larsson L, Eriksson T (2009) A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. J Eval Clin Pract (in press)

  22. Leape LL (1995) Preventing adverse drug events. Am J Health Syst Pharm 52(4):379–382

    PubMed  CAS  Google Scholar 

  23. van der Kam WJ, Meyboom de Jong B, Tromp TF, Moorman PW, van der Lei J (2001) Effects of electronic communication between the GP and the pharmacist. The quality of medication data on admission and after discharge. Fam Pract 18(6):605–609

    Article  PubMed  Google Scholar 

  24. Pillai A, Thomas SS, Garg M (2004) The electronic immediate discharge document: experience from the South West of Scotland. Inform Prim Care 12(2):67–73

    PubMed  Google Scholar 

  25. Booij AD, de Boer WO, Kokenberg ME, Tromp TF (2003) Interventions in seamless care. Pharm World Sci 25(2):41–42

    Article  PubMed  Google Scholar 

  26. Dvorak SR, McCoy RA, Voss GD (1998) Continuity of care from acute to ambulatory care setting. Am J Health Syst Pharm 55(23):2500–2504

    PubMed  CAS  Google Scholar 

  27. Bolas H, Brookes K, Scott M, McElnay J (2004) Evaluation of a hospital-based community liaison pharmacy service in Northern Ireland. Pharm World Sci 26(2):114–120

    Article  PubMed  Google Scholar 

  28. Cameron B (1994) The impact of pharmacy discharge planning on continuity of care. Can J Hosp Pharm 47(3):101–109

    PubMed  CAS  Google Scholar 

  29. Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H (2002) The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol 54(6):657–664. doi:10.1046/j.1365-2125.2002.01707

    Article  PubMed  CAS  Google Scholar 

  30. Sandler DA, Heaton C, Garner ST, Mitchell JR (1989) Patients’ and general practitioners’ satisfaction with information given on discharge from hospital: audit of a new information card. BMJ 299(6714):1511–1513

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

First, we would like to thank the students Helena Lindholm and Cecilia Bergkvist for collecting the majority of the data. We would also like to thank the staff at the Department of Internal Medicine at Landskrona Hospital, especially Dr Per Löfdahl, the nurses in the community health care, and the clinical pharmacists Sofia Jönsson and Emma Olsson for excellent cooperation and work.

Funding

We are grateful to the National Board of Health and Welfare, the Swedish Academy of Pharmaceutical Sciences, the County of Skåne and Apoteket AB for funding the study.

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Correspondence to Anna Bergkvist.

Appendices

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Appendix 2

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Bergkvist, A., Midlöv, P., Höglund, P. et al. Improved quality in the hospital discharge summary reduces medication errors—LIMM: Landskrona Integrated Medicines Management. Eur J Clin Pharmacol 65, 1037–1046 (2009). https://doi.org/10.1007/s00228-009-0680-1

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  • DOI: https://doi.org/10.1007/s00228-009-0680-1

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