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FarmaCenter: a platform for resolving pharmacotherapeutic queries after discharge from the emergency department

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European Statement

Clinical Pharmacy Services

Author(s)

BEATRIZ TORROBA-SANZ, CRISTINA ORTEGA-NAVARRO, ANA DE LORENZO-PINTO, CARMEN REDONDO-GALAN, JUAN ANTONIO ANDUEZA-LILLO, MARTA SANCHEZ-CELAYA POZO, ANA HERRANZ-ALONSO, MARÍA SANJURJO-SAEZ

Why was it done?

Almost half of the patients discharged from the ED receive incomplete information at discharge and they forget approximately 60% of the medical information received when they leave the hospital. All these hinders the proper management of medication at home, generating anxiety to patients and favoring the appearance of adverse events and new visits to the hospital.

What was done?

We have designed, implemented and evaluated a tool to resolve pharmacotherapeutic queries of patients discharged from the Emergency Department (ED).

How was it done?

Patients with doubts about the pharmacological treatment prescribed upon discharge can contact FarmaCenter through the instructions included in the discharge report (telephone/email). The pharmacist will then analyze each query, gathering information from the clinical history and, if necessary, contact the care-team for resolution. Finally, the pharmacist will contact the patient, resolve the query and offer the opportunity to complete a satisfaction survey.

What has been achieved?

766 consultations were received (November 2022- 31 August 2023), mean age was 49.8 years and 49.3% were men. The majority (96%) contacted by telephone and the mean time of resolution was 1.5 hours. Half of the cases (53.7%) were resolved by the hospital pharmacist without the necessity of contacting the rest of the healthcare team. The main reasons for consultation were: medication not prescribed (28.3%), drug administration (8.7%), management of adverse reactions (6.9%), shortages (6.8%), dosage (5.9%) and duration of treatment (5.7%). 15.5% of consultations were not related to medication. The satisfaction survey was sent to 288 patients and 40% responded. The overall rating was 4.9/5 and the most highly valued aspects were the individualized attention, fast resolution of the query and the pharmacist’s kindness. In addition, 95% of patients considered that FarmaCenter had helped them to avoid a visit to a healthcare center.

What next?

Developing improvement strategies to reduce the number of patients with medication-related concerns from the ED.

IMPROVING PATIENT FLOW: NOVEL APPROACH TO COMPLETING DISCHARGE SUMMARIES BY PHARMACIST PRESCRIBERS

European Statement

Clinical Pharmacy Services

Author(s)

Louisa Kasprowicz, Elizabeth Wright, Tejal Vaghela, Mohan Thaoa

Why was it done?

The time taken from decision to discharge to discharge summary written on average was 2.5 hours prior to the new service as the clinicians completed the ward rounds before starting on completing the discharge summaries. Prior to implementation of this service the prescribing error rate was 24% and the accuracy of information (medicines started, discontinued and altered during admission) transferred to general practitioners (GPs) was 44%.

What was done?

The novel approach to completing full discharge summaries by independent pharmacist prescribers (PP) was implemented in a busy admissions unit at a large district general hospital in the east of England. PP writing discharge summaries are recommended in the ECIP, Carter and hospital transformation plans.1 2 We introduced the completion of a full discharge summary by PP instead of a medication-only list currently carried out by other NHS Trusts. The aim was to reduce prescribing errors, improve patient flow through AAU and to reduce pressure on the emergency department.

How was it done?

A pharmacist prescribing a discharge service from 9am to 3pm was proposed for patients who have been admitted for < 48 hours. The medical team bleeped the PP when a patient was being discharged to alert the PP. The primary aim of the service was to increase the number of discharge summaries completed before 3pm, reduce the prescribing error rate and to improve the accuracy of information transferred to GPs. The time of 3pm was chosen to allow the clinicians to complete urgent jobs after the ward round.

What has been achieved?

The data showed that after the implementation of the pharmacist prescribing service, 34% of discharge summaries were completed by PP compared to 0% prior to implementation. This released junior doctors time from completed discharge summaries to concentrate on urgent clinical duties. This also meant discharge summaries were received by the pharmacy in a timelier manner and patients were ready for discharge earlier in the day. The prescribing error rate was reduced to 0.9% and the accuracy of information to GPs was increased to 98% on discharges summaries completed by PP compared to junior doctors’ discharge.

What next?

This new service has made a positive impact on the discharge flow from AAU. Patients are receiving their discharge medications earlier so improving patient flow and patient experience through the department. The service has received positive feedback from patients, the lead consultant, doctors and nursing staff. It is hoped in the future this service could be extended until 5pm and rolled out to other areas in the hospital.

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