Kerstenetzky-Brenny L, Adamsick ML, Lauscher RL, Kennelty KA, Hager DR. Pharmacist discharge summary: Impact of inpatient to community pharmacist handoff at hospital discharge.
J Am Pharm Assoc (2003) 2023;
63:198-203.e4. [PMID:
36064524 DOI:
10.1016/j.japh.2022.08.005]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 08/03/2022] [Accepted: 08/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND
Community pharmacists are often the initial health professionals whom patients encounter after hospital discharge but are rarely provided relevant discharge information.
OBJECTIVES
Implement a pharmacist-to-pharmacist discharge summary (P2PDS) to improve the safety of pharmacist care provision to patients transitioning home from the hospital.
PRACTICE DESCRIPTION
Inpatient pharmacists at an academic medical center conduct discharge medication reconciliation and release discharge electronic prescriptions to dispensing pharmacies.
PRACTICE INNOVATION
A multidisciplinary intersystem quality improvement project was conducted to demonstrate the impact of clinical information sharing via the P2PDS to community pharmacists.
EVALUATION METHODS
With input from community pharmacists, the P2PDS was created and implemented on inpatient units throughout the health system. Outcomes assessed included identification of medication discrepancies, enrollment into reimbursable medication management services, and pharmacist confidence when filling discharge prescriptions.
RESULTS
During the study period, community pharmacists identified a total of 388 medication discrepancies in 161 patients; 16% of discrepancies were considered "unintentional." Twenty-five discharging patients were identified for enrollment in medication management services, with 20 of these patients enrolling in all 3 services (medication delivery, synchronization, and medication packaging). The P2PDS increased community pharmacist confidence in discharge medication filling (40% vs. 95%, P < 0.001) and increased the percent of patients receiving community pharmacist medication reconciliation (14%-76%, P < 0.001).
CONCLUSION
Enhancing pharmacist communication across practice settings with a P2PDS decreases care fragmentation through identification of medication discrepancies and improves pharmacist confidence in patient care provision.
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