what medications are our patients taking at home? medication discrepancies after discharge from a...
TRANSCRIPT
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???