MacDonald Kelly, Cusack Marsha, Liang Su Qiong Rebecca, Rinco Kilby
, BScPharm, is a Pharmacist with Queen Elizabeth Hospital, Charlottetown, Prince Edward Island.
, BScPharm, is the Provincial Order Set Analyst for Health PEI, based at Queen Elizabeth Hospital, Charlottetown, Prince Edward Island.
Can J Hosp Pharm. 2017 Nov-Dec;70(6):430-434. doi: 10.4212/cjhp.v70i6.1711. Epub 2017 Dec 21.
Many patients experience adverse events at the time of discharge from hospital, and most of these events are medication-related. To improve patient safety, Health PEI (the health authority for Prince Edward Island) has made medication reconciliation a priority. The Queen Elizabeth Hospital in Charlottetown is one of the few Canadian hospitals with an electronic discharge process. A discharge report has been developed to provide pertinent information to patients at discharge, including a final medication list to be shared with the community pharmacy at the patient's discretion.
To identify care gaps related to the transfer of information for the medication reconciliation part of the electronic discharge process at the Queen Elizabeth Hospital.
The study was conducted on 4 nursing units offering medical and surgical services. Data for the 8-week prospective study (June to August 2016) were collected using a study-specific discharge evaluation checklist and hospital-to-community pharmacy feedback form. All inpatients 65 years of age or older with a hospital stay longer than 4 days who were receiving more than 5 medications on discharge were eligible to participate.
During the study period, data were compiled for the 72 of 154 eligible patients who provided consent. Of these, 69 (96%) had a change in medications. Follow-up showed that 12 (17%) of the 72 discharge reports had reached the patient's community pharmacy; of these, 5 had been sent from a community care or long-term care facility. Fifty-four patients were discharged home, of whom 50 presented to the community pharmacy after discharge, 37 (74%) of these on the day of discharge.
Most community pharmacies did not receive a discharge report from the patient or from the patient's community care or long-term care facility. This represented the largest care gap in the electronic discharge medication reconciliation process at the study hospital.
许多患者在出院时会经历不良事件，其中大多数事件与药物治疗有关。为提高患者安全，爱德华王子岛卫生局（Health PEI）已将药物重整列为优先事项。夏洛特敦的伊丽莎白女王医院是加拿大少数几家采用电子出院流程的医院之一。现已制定出院报告，以便在出院时向患者提供相关信息，包括最终药物清单，患者可自行决定是否与社区药房共享。
确定伊丽莎白女王医院电子出院流程中药物重整部分信息传递相关的护理差距。
该研究在4个提供内科和外科服务的护理单元进行。使用特定研究的出院评估清单和医院至社区药房反馈表收集了为期8周的前瞻性研究（2016年6月至8月）的数据。所有年龄在65岁及以上、住院时间超过4天且出院时服用超过5种药物的住院患者均有资格参与。
在研究期间，为154名符合条件并提供同意的患者中的72名汇编了数据。其中，69名（96%）患者的药物有变化。随访显示，72份出院报告中有12份（17%）已送达患者的社区药房；其中5份是由社区护理机构或长期护理机构发送的。54名患者出院回家，其中50名在出院后前往社区药房，其中37名（74%）在出院当天前往。
大多数社区药房未收到患者或其社区护理机构或长期护理机构的出院报告。这是研究医院电子出院药物重整流程中最大的护理差距。
