Editor, – In the editorial about discharge medication (Aust Prescr 2006;29:58-9), the authors state 'trials of interventions to improve the transfer of drug information from the hospital to the community have been disappointing'. We recently conducted a randomised controlled trial of a multifaceted intervention called Med eSupport, which included information and communication technology solutions. This trial involved 487 patients across five sites, and included the following elements:
- a secure bi-directional electronic communication pathway between community and hospital pharmacies for the transfer of medication profiles to facilitate medication reconciliation
- supply of a comprehensive medication information sheet at discharge to the patient or carer, general practitioner and community pharmacist, which is uploaded to a secure website for viewing and printing
- a model system in which patients were automatically referred for a post-discharge medicines review within 5-7 days of discharge.
Initially, we found that 66% of all hospital drug charts contained at least one error. Significantly more patients in the intervention group had medication discrepancies resolved within 48 hours of their admission compared with control patients. Almost all of the medicines reviews started by the hospital were completed in a timely manner and were highly appreciated by patients and general practitioners. Only 0.6% of the intervention patients were re-admitted to hospital within five days of discharge compared to 3% of the control patients. An economic evaluation indicated potential savings of $60 million per year with a national roll-out to 50 sites.
We believe the results illustrate the value of developing a strategy for the national roll-out of a medication information sharing process and post-discharge medication reviews for high-risk patients.
Gregory M Peterson
Professor
Shane L Jackson
Research Associate
Anna Tompson
Med eSupport Project Manager
Unit for Medication Outcomes Research and Education
School of Pharmacy
University of Tasmania
Hobart
Editor, – We read with interest the editorial 'Discharge medication' (Aust Prescr 2006;29:58-9). Communication between hospitals and community-based providers with regards to patient medication is less than adequate.1This is of particular concern with warfarin therapy.2,3
We have conducted an audit of 51 consecutive electronic discharge letters of patients who started warfarin while in hospital. This focused on the clinically important issues of indication and dosing. Warfarin therapy and its indication were documented in 50 of the 51 discharge letters, but eight discharge letters (16%) had no dose information. INR test results were present in 29 letters (57%) but only four give a recommended duration of treatment.
While it is not feasible to list every single detail of a patient's medication regimen in a discharge letter, it is reasonable to mention that the patient is taking warfarin, the indication, the dose being taken, any INR results, the recommended target INR range and the next review date of warfarin therapy. We have therefore modified our electronic discharge summaries to include a mandatory field requesting this information. This should help general practitioners continue the clinical care with minimal harm and inconvenience to the patient.
Luigi Gaetani
Senior Clinical Pharmacist
Wollongong Hospital
Wollongong, NSW
Bradley Thomas
Quality Use of Medicine Student
University of Queensland
Brisbane
Editor, – Further to the editorial 'Discharge medication' (Aust Prescr 2006;29:58-9), readers may be interested to learn of South Australian initiatives on this topic.
As part of the careconnect.sa programme (formerly known as Open architecture clinical information system (OACIS)), paper-based hospital discharge summaries are being replaced by a standardised web-based application. Summaries can be automatically faxed via computer to the relevant general practitioner or specialist, or emailed to desktop patient management systems.
Approximately 60% of all hospital discharge summaries in the eight major Adelaide hospitals are now completed this way. Over 125 000 completed summaries are stored within the system and are accessible to treating clinicians at Adelaide public hospitals. New summaries are being generated at a rate of approximately 220 per day.
Legibility problems are now avoided. Changes in discharge medication as well as reasons for these changes must be declared. The duration of treatments must also be stated. The summary may be accompanied by an interim medication list which can be reviewed by the hospital pharmacist before discharge. If a patient is re-admitted the previous discharge medications can be imported into the new summary, reducing errors.
South Australia has improved practice in this area, nevertheless thoroughness and timeliness in clinical practice remain paramount.
Peter Herriot
Consultant Psychiatrist and OACIS Clinical Sponsor
Noarlunga Health Services
Noarlunga Centre, SA
David Taverner
Head, General Medicine
Royal Adelaide Hospital
Adelaide
