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Reconciliation of shared medicine record at discharge: hospital pharmacy ensures correct information on patients’ transition

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European Statement

Patient Safety and Quality Assurance

Author(s)

Linda Jeffery, Maria Grønkjær Abrahamsen, Anja Alrø Bøtkjær, Lotte Aggergaard, Ann Brit Andersen

Why was it done?

Our country has a national SMR for every citizen. The SMR shows the current medication that the citizen has been prescribed, from all sectors. All sectors can see the SMR, which is considered/ought to be the ‘truth’ about the patient’s medication. On discharge from the hospital the SMR is updated by the doctor. Afterwards, pharmacy technicians dispense medicines for discharge. The technicians, at this stage, often find discrepancies in the SMR compared to the medication prescribed and given during admission. The SMR is electronically updated but not adequately reconciled. False information in the SMR may ultimately lead to adverse drug safety events in the primary sector.

What was done?

The regional hospital pharmacy patient safety network studied how many patients do not have a reconciled electronic Shared Medication Record (SMR) at discharge, despite the doctor having electronically updated it.

How was it done?

The technician recorded the discrepancies found before contacting the doctor to get the SMR corrected.
Each discrepancy was reported into the national patient safety database.
The technicians do not dispense medicines to all discharged patients, so our results were extrapolated to all discharged patients in the time period (there was no reason to expect bias).
The study was carried out in the whole region (5 hospitals) during the same week in September 2022.

What has been achieved?

Preliminary data shows that 994 patients were discharged from the wards studied.
Technicians dispensed medicines to 278 patients. They found one or more discrepancies in 65 SMRs (23,4%).
Extrapolation of these results revealed that, in the period, there were potentially 232 patients with drug-related problems from these wards (and approx. 17,000/year in the region).

What next?

Our results showed that the SMR is not adequately reconciled in 23% of discharges, despite the doctor feeling that the task is completed. This gives drug related problems in the primary sector, often resulting in calls to the ward etc. that are time consuming and difficult to solve after discharge. Updating the SMR at discharge is essential for patient safety under transition of care. Our results will be brought to the hospital administrations, patient safety organisations and the regional medicines board for further discussion about the problem and possible solutions.

IMMPACT: A THERAPEUTIC EDUCATION PROGRAM TO SUPPORT SEAMLESS CARE FOR PATIENTS LIVING WITH CANCER

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European Statement

Clinical Pharmacy Services

Author(s)

A. Decottignies, D. Bouchoucha, S. Lévêque, S. Barthier, J.F. Morere, A. Marfaing, A. Rieutord

Why was it done?

Cancer has become a chronic disease. However, the impact of the disease and related treatments on patients’ everyday life remain poorly addressed all along the patient clinical pathway. The objective was to customise support to the patient to be able to better understand and control the disease and treatment consequences.

What was done?

An integrated care model based on a therapeutic education programme (TEP) was designed to better support patients living with cancer in their everyday life. The hospital pharmacy led the project, launched in October 2013 and implemented for patients in March 2015. It is called IMMPACT (impact of illness and medication in patients undergoing chemotherapy). This TEP was accredited by the National Authority (ref No ETP 13/30 in August 2013).

How was it done?

A transprofessional working group was formed. Our concern was to propose a smooth and safe transition from hospital to home. To do so, the hospital set up a partnership with the health network to facilitate seamless care. A prospective survey was conducted in October 2013 including 41 ambulatory patients. Three priority themes were identified: tiredness, haematological problems and digestive disorders management. According to the results, educational sessions have been collaboratively designed and implemented.

What has been achieved?

The patients group workshops began in January 2014. To date, 31 group workshops have been run. These group workshops are facilitated by trained healthcare professionals using educational tools such as Barrows Cards, mosaic characters or metaplan. 83 patients have already experienced this programme. Patient global satisfaction is >92%.

What next?

Given the success of this programme and to fulfil the growing expectations of patients, new sequences are being designed about pain, chemotherapy related neurotoxicity, socio-aesthetics and lymphoedema management as well as developing a serious game for the patient. Finally, IMMPACT extension to community pharmacists is being considered to further sustain patients empowerment and continuity of care.

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