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Int J Clin Pharm. 2015 Dec;37(6):1206-12. doi: 10.1007/s11096-015-0187-z. Epub 2015 Sep 4.

Completeness of medication-related information in discharge letters and post-discharge general practitioner overviews.

Author information

1
Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. elienuitvlugt@hotmail.com.
2
Department of Internal Medicine, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
3
Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
4
Department of General Practice, EMGO Institute VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
5
Department of Hospital Pharmacy, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands. f.karapinar@slaz.nl.

Abstract

BACKGROUND:

Communication and documentation of medication-related information are needed to improve continuity of care.

OBJECTIVE:

To assess the completeness of medication-related information in discharge letters and post-discharge general practitioner (GP)-overviews.

SETTING:

A general teaching hospital in Amsterdam, the Netherlands.

METHOD:

An observational study was performed. Patients from several departments were included after medication reconciliation at hospital discharge. In liaison with the resident and patient, a pharmacy team prepared a Transitional Pharmaceutical Care (TPC)-overview of current medications, including changes and allergies. The resident was instructed to download the TPC-overview into the discharge letter instead of typing a self-made medication list. Medication overviews were gathered from the GP 2 weeks after the handover of the discharge letter. The TPC-overview (gold standard) was compared with the information in the discharge letter and post-discharge GP-overviews regarding correct medications and allergies. Descriptive data analysis was used.

MAIN OUTCOME MEASURE:

The number and percentage of complete medication-related information in the discharge letter and the GP-overview were compared to the TPC-overview.

RESULTS:

Ninety-nine patients were included. Medication-related information was complete in 62 (63 %) of 99 discharge letters. Sixteen of 99 GP-overviews (16 %) were complete. Communication of medication-related information increased documentation by the GP, but the medication history could still be incomplete, mainly regarding medication changes and allergies.

CONCLUSIONS:

Medication-related information is lost in discharge letters and GP-overviews post-discharge despite in-hospital medication reconciliation. This could result in discontinuity of care.

KEYWORDS:

Care transitions; Continuity of care; Hospital discharge; Medication errors; Medication reconciliation

PMID:
26337836
DOI:
10.1007/s11096-015-0187-z
[Indexed for MEDLINE]

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