Authors (including presenting author) :
Wong TC (1)
Affiliation :
(1)Medicine & Geriatrics, Our Lady of Maryknoll Hospital
Introduction :
Nurses preform checking on every discharge prescription to ensure patients discharge with updated and appropriate medication profile. However, some unintentional discrepancies were missed due to time limitation, complicated prescribing history, and multiple follow-up schedule. According to the pharmacy audit, up to 8% of discharge prescriptions were found unintentional discrepancies which required prescriber to review the cases. Those unintentional discrepancies were likely preventable. The discrepancy would lead to medication-related harm to discharge patients. Numerous of studies found that effective medication reconciliations would reduce the risk of medication discrepancies and subsequent medication-related harm to patients. This project tried to reinforce medication safety by means of minimize the discrepancy in discharge medication and enhance the communication with patients and caregivers about the adjustment of medication profiles.
Objectives :
1. To reinforce patient safety by assurance the accurate of discharge medication 2. To enhance the efficiency in the discharge medication management 3. To strengthen the communication with patient and care giver about the discharge medication
Methodology :
The current workflow of discharge medication management was reviewed and modified. Case medical officers (CMO) were invited to prepare discharge prescription before the date of patients’ discharge. Therefore, nurses could perform early checking to rule out if any discrepancy, then verify with CMO if necessary. Moreover, a checklist and reference guide about reconciliation and the checking of discharge medication would be developed so as to ensure the accuracy of discharge medication checking procedure. Besides, a reminder would be provided to discharge patients together with communication in order to notify paitents and caregivers that playing attention to the discontinued medication and duplication of therapy. The program was implemented after the sharing session and last for a month since May, 2021. The satisfaction survey to discharge patients or caregivers, and staff were conducted to collect the feedback of the program.
Result & Outcome :
1. Maintain zero medication error about discharge medication 2. Patients and/or caregivers satisfaction with the provided discharge information, and clear understanding about the discharge medication 3. Reduction of the queries about medication from patients or caregivers after discharge Audit of all discharge prescriptions was performed in order to find out if any missing of discharge medication discrepancy. A total of 93 patients were recruited, 92 patients (98.92%) were discharged without medication discrepancy during the implementation period. Total of 49 discrepancies were screened out from 28 (30.1%) discharge prescription. There was only one case discharged with medication discrepancy, which was about dosages different from on hand medication. Immediate follow-up action was taken to ensure patient adhere to correct drug regimen and adequate drug dispensing. The significant improvement was found while 7 cases discharged with medication discrepancy in April, 2021 (1.08% vs 9.59%; p=0.011). Most of the responded patients or caregivers appreciate the effort of the communication on updating patients’ medication profiles. Moreover, staff have positive feedback and show support to the program.
