How effective is COMMUNICATION between Secondary Care and Primary Care in relation to MEDICATION CHANGES?

Jie Yee Tan1 , Kirsty Green1 , Dilani Perera1

1 Older Person’s Medicine, James Cook University Hospital, South Tees NHS Trust

Introduction

• General Practitioners are not often aware of medication changes during inpatient stays due to omission of information in discharge letters

• For patients this can lead to regular medications not being continued, or patients receiving wrong dosages

• For healthcare professionals it can result in confusion

• Therefore, communication with primary care is essential in older person's medicine (OPM) as these patients have multiple co-morbidities and are often affected by polypharmacy.

*Medication changes: Including medications stopped/ medications started/ medications altered)

Aim of Audit

1. Review and inform local OPM department regarding compliance with the local standards of discharge medication lists

2. Identify and implement ways to improve communication with primary care colleagues regarding medication changes during inpatient stays.

What Are We Doing To Improve

• The results highlight the importance of improving our communication with primary care when it comes to medication changes during inpatient stay.

To improve we are doing a number of things:

Methods

• A retrospective study.

• Data was collected from the electronic discharge summary system for discharges from the OPM ward in August 2022.

• Standards were identified from the local protocol (G148- Medicines Reconciliation for All Admitted Adult Patients), we looked at:

1. Accuracy of discharge medications lists with regards to the current prescribed medications which include patient’s regular medications and the medications started during inpatient stay

2. Documented dose alterations and rationale

3. Rationale for discontinuation of medication

4. Documented indications for newly prescribed medication

Results

• Standard was set at 100%

• No sub-category hit the target of 100%.

• Only 61% of discharge letters documented the reason why new medications had been started

• 75% documented why medications had been stopped.

• 91% documented the reason for dosage changes.

1. Informative posters are to be placed on the OPM ward to increase awareness of the importance of accurate medication paperwork on discharge

2. Present our findings at the OPM departmental meeting.

3. Work with the electronic prescribing system’s (ePMA) colleagues, pharmacist and GPs with interest in informatics to implement a way to automatically transfer the admission medications into the discharge letters, so that we can list whether they are new, stopped or changed in the newest version of the system.