what medications are our patients taking at home? medication discrepancies after discharge from a...
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WHAT MEDICATIONS ARE OUR PATIENTS
TAKING AT HOME?
MEDICATION DISCREPANCIES AFTER DISCHARGE FROM ARURAL DISTRICT HOSPITAL
THE SCENARIO
THE STUDY
• HETI RURAL RESEARCH CAPACITY BUILDING PROGRAM
• The aim of this study was to investigate the research question: Are patients discharged from an Australian rural hospital taking their medication as documented in their hospital discharge summary within one month of discharge?
METHOD
• This study used a cross sectional survey design which involved using semi-structured telephone interviews of patients discharged from the medical teams of a 162 bed general NSW based rural hospital.
• The semi-structured interview questions were designed to ascertain whether there were any discrepancies between medications documented on discharge from hospital and those reported by the patient within a month of discharge.
PARTICIPANTS
• 96 initially enrolled
• 71 (74%) finally interviewed:
• 14 could not contact
• 7 in another care facility
• 4 withdrew consent on telephone contact
• 66 finally analysed
• 5 no completed discharge summary
TELEPHONE QUESTIONNAIRE
• What medication are you taking now
• Prompt sheet
• Compared to medication documented on discharge summary
DISCREPANCIES DOCUMENTED & CLASSIFIED
• Medical officer initiated
• Patient led
• Continuing previous regime
• Medication not considered significant – script not filled
• Medication too expensive
• Medication caused side effects
• Other as specified by patient
CHARACTERISTICS Mean (range)
Age in years 75 (42-92)Length of stay days 5.5 (2-26)Number of medications on discharge summary 8.8 (2-19)Median number of medication on discharge summary 9 ( 6-10.8) *Number of medication changes during admission from discharge summary
3 (0-10)
N (%) Gender
Male 31 (47%)Female 35 (53%)
Principal Diagnosis †Diseases and disorders of the respiratory system 10 (15.2%)Diseases and disorders of the circulatory system 20 (30.3%)Diseases and disorders of the musculoskeletal system and connective tissue
7 (10.6%)
Infectious and parasitic diseases 11 (16.7%)
Appointment with Medical officer post discharge 55 (83%)Within 7 days (46 with GP 3 with specialist) 49 (74%)Longer than 7 days 6 (9%)No medical officer appointment between discharge and follow up phone call (>13 days)
11 (17%)
Discharge information given at discharge – as reported by participant (%)
Yes 25 (38%)No 29 (44%)Don’t remember 12 (18%)
Pharmacy Medication list given - as reported by participant
Yes 45 (68%)No or don’t remember 21 (32%)
Medication manager Self 50 (77%)Carer 12 (18%)Both 4 (6%)
Adherence Measure¶ Low 13 (20%)Medium 14 (21%)High 39 (59%)
Dosage Administration Aid usedYes 20 (33%)No 46 (66%)
RESULTS – NUMBER OF DISCREPANCIES PER PARTICIPANT
NUMBER OF DISCREPANCIES PER
PARTICIPANT
NUMBER OF PARTICIPANTS
TYPE OF DISCREPANCIES
TOTAL NUMBER OF
DISCREPANCIESADDITIONS OMISSIONS
CHANGED DRUGSAME CLASS
CHANGED DOSE
0 5 0 0 0 0 0
1 8 4 3 0 1 8
2 19 18 11 4 5 38
3 10 22 4 1 3 30
4 6 16 8 0 0 24
5 6 17 9 2 2 30
6 5 23 4 1 2 30
7 3 18 0 1 2 21
> 8 4 30 12 1 4 47
OR TO PUT IT A DIFFERENT WAY….
NUMBER OF DISCREPANCIES PER
PARTICIPANT
NUMBER OF PARTICIPANTS
TYPE OF DISCREPANCIES
TOTAL NUMBER OF
DISCREPANCIESADDITION
SOMISSION
S
CHANGED DRUGSAME CLASS
CHANGED DOSE
0 5 0 0 0 0 0
1 or more 61 148 51 10 19 228
3 or more 33 124 38 5 13 180
5 or more 18 88 26 5 10 129
8 or more 4 30 13 1 4 48
N (%)
TOTAL NUMBER OF DISCREPANCIES 228 (100%)
ADDITIONS – COMPARED TO DISCHARGE SUMMARY 148 (65%)
ADDITIONS - EXCLUDING OTC AND CAM 82 (36%)
OMISSIONS – COMPARED TO DISCHARGE SUMMARY 51 (22.4%)
OMISSIONS – EXCLUDING OTC AND CAM 45 (19.7%)
CHANGED DRUG – SAME PHARMACOLOGICAL CLASS - 10 (4.4%)
CHANGED DOSE - COMPARED TO DISCHARGE SUMMARY 19 (8.3%)
TYPE OF DISCREPANCIES
ADDED MEDICATIONDRUG GROUP EXAMPLE OF MEDICATIONS
Analgesics Oxycodone, paracetamol/codeine, tramadol, gabapentin Blood and electrolytes
Warfarin x 2, Potassium chloride,
Cardivascular amiodarone, atorvastatin, digoxin, diltiazem, frusemide, glyceryl trinitrate patch, spironolactone, telmisartan + hydrochlorothiazide
Endocrine risedronateGastrointestinal esomeprazole, pantoprazole, sucralfateGenitourinary oxybutyninImmunomodulators prednisoloneMuscular skeletal allopurinolPsychotropic diazepam, mirtazepine, nitrazepam, risperidoneRespiratory salbutamol, tiotropium, Seretide®, Symbicort®,
(numerous)
OMITTED MEDICATION
DRUG GROUP MEDICATIONSANALGESICS Gabapentin, oxycodoneBLOOD AND ELECTROLYTES Aspirin x 4, potassium chloride,CARDIVASCULAR diltiazem, irbesartan + hydrochlorothiazide,
spironolactone,
EAR NOSE THROAT betahistineGASTROINTESTINAL esomeprazole, pantoprazole, prochlorperazine,
metoclopramide
GENITOURINARY Prazosin tamsulosinRESPIRATORY Bromhexine, tiotropium, ‘Seretide’, ‘Symbicort’
OTC AND CAM calcium, cyanocobalamin, magnesium, thiamine, vitamin D
REASON N (%)MEDICAL OFFICER THERAPEUTIC CHANGE POST DISCHARGE - NUMBER OF INTENTIONAL DISCREPANCIES (%)
73 (32%)
PARTICIPANT LED CHANGE – TOTAL 155 (68%)
PARTICIPANT CONTINUING PREVIOUS REGIME 129 (57%)
PRESCRIBED MEDICATION THOUGHT NOT NECESSARY – DIDN’T FILL SCRIPT OR BUY MEDICINE
20 (9%)
PARTICIPANT DIDN’T KNOW OF CHANGES/FORGOT 4 (2%)
MEDICATION TOO EXPENSIVE 1 (0.4%)
MEDICATION CAUSED SIDE EFFECT – CEASED 1 (0.4%)
REASON FOR DISCREPANCY
CONCLUSIONS
• In conclusion, this study has demonstrated that within a month after discharge from an Australian rural hospital the participants are not taking their medication as documented in their hospital discharge summary.
RECOMMENDATION
• This study has demonstrated a problem with the continuity of care in terms of medication discrepancy for patients discharged from our rural hospital.
• Medication reconciliation at all points of the health care cycle
• MMP
• Improved communication of changes
• eHealth???
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