1. QUM Indicator 5.3 A Quality Improvement Program Ensuring explanations for changes to medication therapy in the discharge summary Presenter Insert your hospital logo here

2. Explaining changes on the discharge medicines list Overview Background Aims and methods Feedback on current practices Education- ‘Support 4 Success’ Questions

3. Explaining changes on the discharge medicines list Background NSW Therapeutic Advisory Group (NSW TAG) survey to identify top 3 issues in medication safety. -SAFER Medicines Group -TAG and TAG Net members Top issue to address: Medication changes and explanations for changes in the discharge summary

4. Explaining changes on the discharge medicines list About NSW TAG Independent, not-for-profit organisation Membership consisting of clinical pharmacologists, pharmacists and other clinicians from teaching hospitals Representatives from every Drug and Therapeutics Committee across NSW. Core goal to promote the Quality Use of Medicines www.nswtag.org.au

5. Explaining changes on the discharge medicines list What is the purpose of the discharge summary? Frequently, the discharge summary is the only communication provided to the General Practitioner (GP) about their patients’ and the events that occurred whilst their patients’ were in hospital.

6. Explaining changes on the discharge medicines list Medication Error and ADEs Transferring patients are those most vulnerable. 1 Poor quality communication 1

7. Explaining changes on the discharge medicines list Identified gaps in practice “Inaccurate, incomplete and illegible” information are common deficiencies within the discharge summary 2 In the medicines list: -Omitted medications 3,4 -Medication not previously prescribed (or justified) 3,4

8. Explaining changes on the discharge medicines list Aims 1.To use drug use evaluation (DUE) methodology to describe the extent to which explanations for medicine therapy changes are being documented in discharge summaries from participating NSW and ACT hospitals. 2. To increase awareness of the APAC Guiding Principles within the hospital setting, in particular “communicating medicines information” (Guiding Principle 9). 5 3. To optimise the discharge summary as a communication tool to General Practitioners (GPs) on explanations for alterations to patients’ medicine therapy.

9. Explaining changes on the discharge medicines list QUM Indicator 5.3 What are the Quality Use of Medicine (QUM) Indicators? QUM Indicator 5.3 aims to measure 6 : Percentage of discharge summaries that include medication therapy changes and explanations for changes Quality improvement initiative involving 16 hospitals across NSW/ACT

10. Explaining changes on the discharge medicines list

11. Defining “changes” to and “explanations” for medication therapy? Refers to changes to the patient’s pre-admission regimen which are intended to continue after discharge 2 –New medication –Change in the dose, form, route or frequency of a medicine taken prior to admission –Cessation of a medicine taken prior to admission Explanations for changes: Should include sufficient detail to inform future management decisions in the discharge summary or discharge letter.

12. Explaining changes on the discharge medicines list Completing high quality discharge summaries National E-Health Transition Authority (NEHTA) Continuity of Care program March 2010 7 Barriers include: devaluing of discharge summaries over emphasis on coding requirements uncertainty over what information a GP desires

13. Explaining changes on the discharge medicines list Support for quality improvement in the discharge summary Work toward improving the processes and forms required to produce a quality discharge summary is underway. Nationally: Australian Pharmaceutical Advisory Council (APAC) National E-Health Transition Authority (NEHTA) Australian Commission for Safety and Quality in Health Care Statewide: NSW Health Systems Support Forms committee NSW Therapeutic Advisory Group NSW/ACT program (QUM Indicator 5.3)

14. Explaining changes on the discharge medicines list DUE Methodology Feedback SHPA Drug Use Evaluation Cycle 8

15. Explaining changes on the discharge medicines list Program Methods Ethics approval Support from senior clinicians Data collection Education and Feedback Data collection Evaluation, Feedback and Sustainability August 2010 June 2011

16. Explaining changes on the discharge medicines list Pre-intervention results continued HospitalNSW/ACT Baseline Patients discharged where a discharge summary is documented in the notes Patients who had medication reconciliation undertaken on admission Discharge summaries which comply with NSW Policy (PD2007_092) for a documented list of medications on admission and on discharge

17. Explaining changes on the discharge medicines list Pre-intervention results HospitalNSW/ACT Baseline Discharge summaries which should have explanations for medicine therapy changes Discharge summaries which document all changes to medicine therapy Number of medicine therapy changes which require an explanation Of those, proportion which had a documented explanation for the change

18. Explaining changes on the discharge medicines list Pre-intervention results continued… HospitalNSW/ACT Baseline Of the discharge summaries reviewed, those which were computer generated Discharge summary templates prompting documentation for changes to medications Number of discharge summary templates reviewed

19. Explaining changes on the discharge medicines list Discussion Encouraging aspects of our results Aspects to improve

20. Explaining changes on the discharge medicines list EDUCATION

21. Explaining changes on the discharge medicines list Educational Tools: Expert Advisory Committee Clinical Education and Training Institute (CETI) Representatives: –JMO Forum –Prevocational Training Council / Director Medical Services Head of Department, General Paediatrics General Practitioner Education and Training Pharmacist Quality Manager Head of Department, Clinical Pharmacology

22. Explaining changes on the discharge medicines list Educational Intervention Tools Discharge Summary Workshop “Top Tips” lanyard cards Checklist for JMO Term Supervisors Feedback presentation today!

23. Explaining changes on the discharge medicines list Discharge Summary Workshop Target audience: Junior Medical Officers Consists of: -PowerPoint® presentation (Good, great and ugly discharge summary examples) -Practical case examples and activities

24. Explaining changes on the discharge medicines list Lanyard Cards

25. Explaining changes on the discharge medicines list Checklist for JMO Term Supervisors

26. Explaining changes on the discharge medicines list Support 4 Success! Many staff members can provide support and contribute to make this program an successful JMOs Term supervisors and their senior team members Pharmacists Nursing

27. Explaining changes on the discharge medicines list Hospital Program Contacts Clinical Champion: xxxxx Local Project Team: xxxxx

28. Explaining changes on the discharge medicines list References 1.Easton K, Morgan T, Williamson M. Medication safety in the community: A review of the literature. National Prescribing service. Sydney, June 2009. 2. Wong JD, Bajcar JM, Wong GG et al. Medication reconciliation at hospital discharge: Evaluating Discrepancies. Ann Pharmacother 2008;42:1373-1379. 3. Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential. Int J for Qual in Health Care 2005; 17(1):15-22. 4. Perren A, Previsdomini M, Cerutti B, et al. Omitted and unjustified medications in the discharge summary. Qual Saf Health Care 2009;18:205-208. 5.Guiding principles to achieve medication management: Australian Pharmaceutical Advisory Council; 2005:1-55. 6. Indicators for Quality Use of Medicines in Australian Hospitals: NSW Therapeutic Advisory Group, 2007. 7.Continuity of Care Program- National E-Health Transition Authority, March 2010: Issues and barriers faced by Junior Hospital Doctors for the Implementation of the Discharge Summary (unpublished) 8. SHPA Committee of Specialty Practice in Drug Use Evaluation. SHPA Standards of Practice for Drug Use Evaluation in Australian Hospitals. JPPR 2004; 34(3): 220-222..

29. Explaining changes on the discharge medicines list Acknowledgements NSW TAG –SAFER Medicines Group –Drug Use Evaluation Support Group Indicator 5.3 Expert Advisory Committee

30. Explaining changes on the discharge medicines list Questions/Discussion