Communication regarding adverse drug reactions between secondary and primary care: a postal questionnaire survey of general practitioners

Discharge summary medication list accuracy across five metropolitan hospitals: a retrospective medical record audit

ObjectiveTo determine the accuracy of discharge summary (DS) medication lists across a broad cross-section of hospital inpatients and to determine what factors may be associated with errors in this document.MethodsA retrospective medical record audit was undertaken at five metropolitan hospitals that utilise an electronic medication management system (eMMS) at the point of discharge. Four hospitals utilised an eMMS for inpatient medication management, with the fifth utilising the paper-based National Inpatient Medication Chart (NIMC). Any inpatients discharged during the first week of February, May, August and November 2020 and February 2021 were included if they received both a DS and either a pharmacy-generated patient-friendly medication list or interim medication administration chart.ResultsEight-hundred and one DSs were included, of which 525 (66%) had one or more medication errors and 220 (27%) had one or more high-risk medication errors. A higher proportion of patients with polypharmacy (five or more medications) had one or more errors compared to patients without polypharmacy (67% vs 54%, P < 0.01). DSs generated from the site with paper NIMCs were less likely to have one or more errors when compared to sites using an inpatient eMMS (58% vs 68%, P < 0.01). Age, sex, language spoken and preparing the DS post-discharge were not associated with differing rates of errors. Of the 2609 individual medication errors (390 high-risk errors), the most common types were 'omitted drug or dose' (34%) and 'unnecessary drug' (33%).ConclusionMedication errors in the DS are common and more likely to occur in patients with polypharmacy.

Adverse drug reaction management in hospital settings: review on practice variations, quality indicators and education focus

Purpose

Adverse drug reactions (ADRs) contribute significantly to healthcare burden. However, they are largely preventable through appropriate management processes. This narrative review aims to identify the quality indicators that should be considered for routine monitoring of processes within hospital ADR management systems. It also examines the potential reasons behind variation in ADR management practices amongst HCPs, and explores possible solutions, focusing on targeted education programmes, to improve both the quality and quantity indicators of ADR management processes.

Methods

A comprehensive literature review was conducted to explore relevant themes and topics concerning ADR management, quality indicators and educational interventions.

Results

Substantial variability exists in ADR management amongst healthcare professionals (HCPs) with regard to reporting rates, characteristics of ADRs reported, quality of assessment, completeness of reports and, most importantly, risk communication practices. These variable practices not only threaten patient safety but also undermine pharmacovigilance processes. To date, quality indicators to monitor ADR management practices within hospital settings remain ill-defined. Furthermore, evidence behind effective interventions, especially in the form of targeted education strategies, to improve the quality of ADR management remains limited.

Conclusions

The focus of ADR management in hospitals should be to promote patient safety through comprehensive assessment, risk communication and safe prescribing. There is a need to develop a system to define, measure and monitor the quality of ADR management. Educational strategies may help improve the quality of ADR management processes.

Development of video animations to encourage patient-driven deprescribing: A Team Alice Study

OBJECTIVE

Patient-driven deprescribing initiatives aim to increase patient knowledge and strengthen self-advocacy skills. This article describes the development of three animated videos designed to educate older adults about unsafe prescribing and medication harm, based on the actionable lessons from the death, by polypharmacy, of an older adult in our community.

METHODS

Using a community based participatory research approach (CBPR), members of three senior centers (n = 53) and the Deprescribing Partnership of Western New York (n = 30) were recruited and participated in two rounds of focus groups to guide the video development.

RESULTS

Stakeholder input led to changes in content, wording, and visual presentation. The final versions of the videos emphasize the following messages (1) "New medications and what you should know about the risks", (2) "What you should do when a doctor tells you never to take a certain medication", (3) "What you should know about medications when you are in the hospital."

CONCLUSION

The study highlights the successful process of using CBPR to develop a series of videos designed to provide information on the risks of polypharmacy, and empower older adults to advocate for themselves.

PRACTICE IMPLICATIONS

Animated educational videos are a novel strategy to address medication harm in older adults. This research is a critical first step to increasing patient-led discussions that reduce the incidence of medication harm and inappropriate medication use among older adults.

Non-systematic review: Correspondence quality and interoperability between family physicians and hospital clinicians

BACKGROUND

Medical correspondence between physicians working in the community and in hospital is paramount to provide continuity of care, but there is no agreement on what constitutes a good quality letter, not even interest by some clinicians on this interface. Information flow could be faster electronically rather than in paper, but is content improving? What defines a good letter?

AIM

(a) To assess what information should be shared between family doctors and hospital physicians and could it be shared better. (b) To assess the possibility of linking the sections of the letter to SNOMED-CT codes to improve interoperability.

RESULTS

Authors vary regarding what is to be included in communications, and as they also have different needs among services, it creates a very long list of possible items to consider. Standardised templates with their corresponding SNOMED-CT codes are presented.

CONCLUSION

Standardised correspondence could improve continuity of care. Appropriately coded it could facilitate the information sharing and the data manipulation required to provide an adequate provision of services among primary care or family physicians and hospitals or secondary care organisations. It could also serve as a tool to assess clinicians' performance.

Adverse drug reaction monitoring by United Kingdom hospital pharmacy departments: impact of the introduction of “yellow card” reporting for pharmacists

Objective

To assess the impact of the introduction of hospital pharmacist “yellow card” adverse drug reaction (ADR) reporting on the operation of local schemes.

Method

Prepiloted postal questionnaire sent to hospitals in 1998 following up a previous survey two years earlier.

Setting

Clinical services managers for 200 hospital pharmacies that had been randomly selected for the previous survey.

Key findings

One hundred and fifty usable questionnaires (75 per cent) were returned. Twenty-eight departments (18.9 per cent), compared with 26 departments (15.1 per cent) in 1996, operated ADR reporting schemes. Of a total of 440 local ADR reports made to participating departments, 70.0 per cent (312) were forwarded to the Committee on Safety of Medicines, a significantly higher percentage than the 14.9 per cent in the previous study (P=0.001). Only eight hospitals (5.4 per cent) had schemes for monitoring newly marketed or “black triangle” drugs. Ninety-four departments (62.3 per cent) had supported education and training activities. Of the hospitals without a scheme, 15 (12.5 per cent) said they had definite plans to introduce one in their hospital, 40 (33.3 per cent) had probable plans to introduce one and 65 (54.2 per cent) had no such plans.

Conclusion

Pharmacists' involvement in the CSM yellow card scheme appears to have had little impact on local initiatives. In areas where these local schemes have been implemented and educational activities provided, drug information pharmacists appear to have a significant role. From the results of this study, even in hospitals with local or in-house schemes, gross under-reporting of ADRs remains a major problem.

[Drug-drug interactions in multicentre polypathological polymedicated patients]

OBJECTIVE

To determine the prevalence of relevant drug-drug interactions (DDIs) and associated predictor factors in a sample of patients with multiple complex chronic diseases (polypathological patients) receiving multiple drug therapy. Our secondary objective was to determine the acceptance of a drug interaction reporting program with recommendations addressed to the prescribing physicians.

SUBJECTS AND METHODS

A cross-sectional study performed in three primary care centres assigned to a teaching hospital. All patients with 2 or more chronic diseases and treated simultaneously with 5 or more drugs were recruited in the study. DDIs were detected by using Drug-Reax System((R)) (Micromedex) program, the Drug Data Base (Bot) Spanish General Council of Official Colleges of Pharmacists or literature search when needed. Those DDIs which, according to the opinion of the pharmacist investigators, required any intervention were considered relevant. Acceptance of the reported DDI recommendations was evaluated by means of a survey addressed by primary care physicians ("acceptable," pertinent recommendation to modify treatment).

RESULTS

A total of 283 polypathological polymedicated patients were included. Mean age was 74.5 years (range 43-100 years). Mean number of diseases per patient was 2.5 and prescriptions 9.7). Out of a total of 2748 drug prescriptions, 1053 DDIs in 250 patients (96.5%) were identified. Of these, 45% were filtered as relevant DDIs. The presence of ischemic heart disease, two or more hospital admissions and having received 7 or more prescriptions were associated with the presence of DDIs. 177 informs containing 473 recommendations about DDIs were sent to primary care physicians from our Pharmacy Department. 339 recommendations were answered by primary care physicians, and 84% were favourably accepted.

CONCLUSIONS

Almost every polypathological polymedicated patient is exposed to at least one DDI and about a 60% would require any intervention. Appropriate filtering and personalising recommendations in a collaborative way may represent an adequate manner to improve the risk-benefit ratio of the drug prescriptions.

A Quality Use of Medicines program for continuity of care in therapeutics from hospital to community

OBJECTIVE

To evaluate adherence to an agreed minimum dataset for patient medication information exchange between hospitals and general practitioners.

DESIGN

Quasi pre-post design with a supplementary post-program comparison group; sequential descriptive surveys of patients following recent discharge from public hospitals; opinion questionnaire for key hospital informants; stakeholder forum to review data and Quality Use of Medicines (QUM) action plans between pre- and post-program surveys.

PARTICIPANTS AND SETTING

GPs and hospitals from the South East Area Health Service, Sydney. During 2000-2001, 81/124 GPs (65%) returned 147 patient questionnaires in initial follow-up; 88/119 GPs (74%) returned 131 questionnaires in final follow-up; a supplementary group of 54/120 GPs (45%) returned 66 questionnaires; 32/45 (71%) of nominated key informants responded to the hospital survey.

RESULTS

Direct notification of GPs by hospitals of their patient's admission was unchanged from the initial level of 22%. The proportion of GPs providing medication information to the hospital increased from 38% to 51% at Stage 2 (P < 0.05) and remained at 52% at Stage 3. The proportion of GPs receiving discharge summaries directly (initially 2%) increased to 26% at Stage 2 (P < 0.001) and remained at 27% at Stage 3.

CONCLUSIONS

System change is slow to occur, but changes that are implemented are maintained. The stakeholder forum suggested that a specific person should be responsible for GP liaison.

Adverse drug reactions as a cause of admission to an acute medical assessment unit: a pilot study

BACKGROUND

In this pilot study, we have investigated the frequency of adverse drug reaction (ADR)-related admissions to an acute medical assessment unit. Although ADRs are thought to be responsible for 5% of hospital admissions, there have been no recent studies in the U.K.

OBJECTIVE

To pilot such a study for estimating the incidence of ADR-related admissions to an acute medical assessment unit.

METHOD

Data were collected for 200 patients including details of concurrent illness, drug usage and reasons for admission. ADRs were assessed for causality using two previously published classification systems.

RESULTS

ADRs were responsible for admission in 15 (7.5%) patients, were present in an additional three (1.5%) patients and may have contributed to the deaths of two (1%) patients. Of the 15 ADRs suspected of causing an admission, three were considered to be 'possible' or 'unlikely', with the remaining 12 considered to be 'probable' or 'certain'. The proportion of patients identified in this study with ADR-related admissions is either similar to or larger than that found in comparable studies carried out in other hospitals. Nearly all ADRs were Type A reactions in that they were predictable and therefore potentially preventable.

CONCLUSION

This study suggests that the proportion of ADR-related admissions has not decreased in the last decade and, given the increasing numbers of acute medical admissions, the absolute numbers may have actually increased. Furthermore, the nature of drugs causing admissions has not changed substantially over the last 20 years. Strategies to reduce the burden of ADR-related admissions are urgently needed.