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Development of My Medication Plan involving Patient Representatives as Co-designers

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European Statement

Clinical Pharmacy Services

Why was it done?

Despite numerous attempts to improve medication information, patients express a need for more information about their drug treatment after discharge from hospital. A consequence of missing information could be unintentional non-adherence or adverse drug events. In Denmark, the electronic Shared Medication Record (SMR) lists the patients’ current drug treatment, but further relevant patient requested information is needed to support patients.

What was done?

A booklet called My Medication Plan was developed as a tool to assist patients in managing their medication treatment. The Design Thinking Framework was applied as a model for involving patient representatives in the development as co-designers.

How was it done?

Three patient representatives from Hospital Sønderjylland participated during two group sessions with the purpose of generating ideas and designs for the My Medication Plan. Brainstorming was applied as an idea generating technique, since it is easy to use and effective in generating ideas in a short time. The ideas from the first session were used as inspiration for six prototypes of the booklet, which were presented and discussed at the second session. The final edition of the My Medication Plan was prepared based on this input.

What has been achieved?

The patient representatives stressed a need for specific instructions about the drugs’ application, boxes to note over-the-counter medication, dietary supplements and herbal remedies, as well as appointments with healthcare professionals to be a part of My Medication Plan. Additionally, free-text space for notes and questions about medication was requested. A non-electronic tool was specifically preferred because patients would have something to look at and write in meanwhile discussion medication changes and appointments. Furthermore, it could also provide relatives the opportunity to seek information about agreements made. According to the patient representatives, the final tool should include a print of the SMR and predefined pages including a glossary of medical terms. The developed tool, My Medication Plan, contains the requested information in an interchangeable design with a print of the SMR and the predefined papers added into plastic sleeves.

What next?

After developing the My Medication Plan, the next step is to use and test the effect of using the tool in relation to a sector transition intervention conducted as a randomised controlled trial.

Improved drug management for surgical inpatients through the presence of a clinical pharmacist at the preoperative clinic

European Statement

Clinical Pharmacy Services

Author(s)

Françoise LONGTON, Olivia Polinard, Linda Mattar, Anna Pauels, Mireille Bourton, Michel Mattens

Why was it done?

A thorough medication history at admission reduces medication errors. The presence of a clinical pharmacist in the preoperative clinic increases the number of inpatients who receive a standardized medication history by a pharmacist.

On admission, the adaptation of home medications to the hospital formulary can also be a source of error or delay. The fact that the patient is seen by a pharmacist prior to hospitalization makes it possible to anticipate drug substitutions and possible orders for non-formulary drugs.

Moreover, surgeons do not always have the possibility to prescribe medications taken at home upon admission, which results in a delayed availability of the medication. Thanks to this multidisciplinary project the continuity of treatment is assured.

What was done?

During the preoperative consultation, a pharmacist takes a medication history and enters it into the computerized medical record, making it available for the anaesthetist.

Upon admission of the patient, the continuity of the medication is ensured by the pharmacy.

Indeed, during the admission, the nurse follows a procedure that informs the pharmacy of any medication changes since the preoperative consultation. Afterwards, the pharmacy encodes the treatment into the computerized intra-hospital prescription and delivers it to the department.

Before any drug administration, this treatment is signed by the doctor responsible for the patient.

How was it done?

Preoperative consultations had to be structured so that each patient was first seen by the pharmacist, second by a nurse and third by the anaesthetist.

Thus, the main obstacle was organizational and it was overcome through the centralized management of preoperative clinic appointments.

What has been achieved?

In 2020, 54% of patients admitted for surgery (elective or emergency surgeries) were seen in the preoperative clinic.

What next?

This is an example of good practice as it ensures a standardized medication history and admission management.

DOES RECORDING OF MEDICATION HISTORY BY PHARMAECONOMIST IN THE EMERGENCY DEPARTMENT HAVE AN EFFECT AT OTHER HOSPITAL DEPARTMENTS? (submitted in 2019)

European Statement

Clinical Pharmacy Services

Author(s)

Maria Abrahamsen

Why was it done?

The aim of the initiative was, among others, to study whether MH by a pharmaconomist in the emergency department has positive effects in other departments. Since the majority of hospitalised patients are admitted through the emergency department it is expected that changes related to admission procedures affect other departments in the cases where patients are hospitalised. In theory recording of MH should be easy, due to the use of Shared Medication Record (FMK). FMK is an updated electronic medication list including all prescriptions filled at pharmacies within the last 2 years. In reality, often neither FMK nor the recorded MH is correct. MH recorded by pharmaconomist or pharmacist is implemented in other emergency departments, but the effect in other hospital departments has yet to be documented.

What was done?

At hospitalisation, part of the routine is to record the patient’s medicinal history. We implemented recording of medicinal history (MH) in the emergency department by a pharmaconomist instead of by a doctor.

How was it done?

The pharmaconomist was present at the emergency department weekdays during daytime to record the MH of newly admitted patients. When the pharmaconomists wasn’t present the doctor recorded the MH. To evaluate the effect in other departments, data registered by pharmaconomists at the department of geriatrics about medicinal changes, types of changes and number of patients with changes were used, combined with hospital data about the number of patients in the geriatric department at a given time. Data from 10 months before the initiative was compared with data from the 9 month test period.

What has been achieved?

At the department of geriatrics both the need for medicine changes due to inadequate MH and the number of patients with medicine changes related to inadequate MH was significantly reduced (p 0.05). The proportion of patients with changes was reduced from 43.7% to 36.9% and the number of changes per patient was reduced from 0.65 to 0.49. For both parameters the reduction is seen immediately after implementing MH by a pharmaconomist in the emergency department. The reduction has released time for nurses, doctors and pharmaconomists working outside the emergency department, though it isn’t possible to quantify the amount of released time.

What next?

Incorporation of a specialised professional such as a pharmaconomist early in a hospitalisation gives doctors, nurses and pharmaconomists working outside the emergency department extra time for other tasks. The effect of the initiative depends on the procedures for admissions since it requires that most patients are admitted through one department at the hospital.

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