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Short paper session 1 – Saturday 12 November
Audit and re-audit of documentation of changes to medicines on discharge in paediatrics at St Mary's Hospital, Imperial College Healthcare NHS Trust
  1. S Mesgarpour,
  2. E L Alford,
  3. P J Fletcher
  1. St Mary's Hospital Pharmacy department, ICHT, London, UK

Abstract

Objectives To measure the communication of changes to medicines on the paediatric discharge summary in relation to the Commissioning for Quality and Innovation (CQUIN)1 target for discharge communication. The target relating to discharge prescriptions specifically communicating details of changes to medicines was initially set at 60%, increasing to 80% by the end of March 2011. To evaluate the effect of the implementation of the Electronic Discharge Communication (EDC) Version 2, designed to be compliant with CQUIN targets. Version 2 of EDC has a template within the medication prescription to indicate if the drug is an unchanged admission drug, a changed admission drug, or a new drug. There is also an indication field, but its completion is not set to be mandatory.

Methods Data collection took place over a 2 week period in May 2010 and a second 2 week period in January 2011. EDC version 2 was implemented in late summer 2010. Discharged patients were identified from daily medical handover summaries. Drug charts and medical notes were obtained to identify new and changed medicines. The EDC was reviewed to identify if changes were clearly documented for the general practitioner. All data collection forms were reviewed by a senior pharmacist for quality assurance. Bone Marrow Transplant, oncology, HIV patients and inter-hospital transfers were excluded.

Results During the initial data collection period, 89 children were discharged. Only 62 (70%) of these patients had a discharge summary. This rose to 97% (114 of 117) in the second period. In the initial period there were 22 patients with medicine changes, but only 8 (36%) had complete documentation on the EDC of the reasons behind the changes. In the second period, 42 patients had medicine changes, with 27 (64%) having the reasons fully documented. In the initial period there were a total of 72 medication changes for the 62 patients with EDCs, 59 of which were new medicines started. Only 24 (33%) of all medicine changes had the reason documented. In the second period there were 66 medication changes for 114 patients with EDCs, 17 of which were new medicines started. Of the 66 medication changes, 38 (58%) had the reason documented.

Conclusion The initial audit results raised the profile of EDC within the paediatric medical team. Prior to EDC version 2 the CQUIN target was not met, however EDC version 2 has been successful in significantly increasing the number of children who get an EDC at the time of discharge. It has also been successful in increasing the number of patients (and corresponding drugs) with documentation relating to changes made. However more work needs to be done to achieve the current target of 80%. A suggested system change would be to make the indication field mandatory.

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