News

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Could discharge summaries be set to improve?

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A guide to help health professionals cut medication-related errors after patients leave hospital has been released by the Australian Commission on Safety and Quality in Health Care (ACSQHC).
 
The new Medication management at transitions of care stewardship framework is the ‘first coordinated, hospital-based approach to manage medicines during this high-risk period for patients’, according to the ACSQHC.
 
Its release comes amid an estimated 250,000 hospital admissions each year are due to medication-related errors, with more than half taking place during transitions of care.
 
With that as the backdrop, the framework highlights the importance of identifying patients at high risk, including people aged over 65 years, those who take five or more medications or a high-risk medication, as well as those with multiple prescribers.
 
Dr Phoebe Holdenson Kimura has been the clinical lead for developing the framework, which she says is an opportunity to strengthen communication between hospital clinicians and primary and aged care.
 
She said there are four key elements to the framework:

• Having good governance over the process
• Ensuring a multidisciplinary stewardship team that meets regularly and puts a coordinated response in place
• Medication management activities
• Monitoring, evaluating and reporting on its impact

‘A lot of this is already happening in the sector, but it’s being implemented in different ways, with different levels of maturity,’ Dr Holdenson Kimura told newsGP.
 
‘What we’re wanting to do is set the bar and have that rolled out and happening more consistently all across Australia.’
 
As a GP herself, Dr Holdenson Kimura says she is passionate about the work ‘because I know how important it is for my patients’.
 
She says a key part is around early discharge planning and communication with primary care.
 
‘We all know that GPs play a critical role in supporting safe transitions of care for patients going into hospital and then being discharged back into the community and into their care,’ she said.
 
‘The framework really stipulates that there’s proactive communication with the general practice ahead of the discharge to communicate any significant medication changes.
 
‘If we see that the stewardship model is implemented effectively in the hospital sector, GPs can expect to receive these really high-quality discharge summaries that have a correct and detailed medication list that not only describes the medication and the dose and the time, but also the reason that medication may have been changed from something that the patient was on previously and why.’
 
She said ensuring patients know their current medication list ahead of a hospital visit, including providing it on paper, is one area where GPs can make a difference.
 
‘We know that when the patient is empowered with the right knowledge that definitely improves the safety of the whole process,’ she said.
 
She also believes digital advances will be a key part of its success, emphasising the need for a system that allows seamless access to different care team members, and has prescribing and dispensing software working well together to help manage discharge.
 
‘It is not going to happen overnight and will probably take time recognising that some jurisdictions are further along in the process than others,’ she said.
 
‘That’s why monitoring, evaluation and reporting is embedded in this framework so that we know whether it’s working, and so that it can continue to undergo that evolution of quality improvement.
 
‘Over time we hopefully will continue to see fewer and fewer of those incidents occurring.’
 
The new framework can be read on the ACSQHC website.
 
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ACSQHC Australian Commission on Safety and Quality in Health Care deprescribing Medications

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