J Am Pharm Assoc (2003). 2023 Jan-Feb;63(1):198-203.e4. doi: 10.1016/j.japh.2022.08.005. Epub 2022 Aug 12.
Community pharmacists are often the initial health professionals whom patients encounter after hospital discharge but are rarely provided relevant discharge information.
Implement a pharmacist-to-pharmacist discharge summary (P2PDS) to improve the safety of pharmacist care provision to patients transitioning home from the hospital.
Inpatient pharmacists at an academic medical center conduct discharge medication reconciliation and release discharge electronic prescriptions to dispensing pharmacies.
A multidisciplinary intersystem quality improvement project was conducted to demonstrate the impact of clinical information sharing via the P2PDS to community pharmacists.
With input from community pharmacists, the P2PDS was created and implemented on inpatient units throughout the health system. Outcomes assessed included identification of medication discrepancies, enrollment into reimbursable medication management services, and pharmacist confidence when filling discharge prescriptions.
During the study period, community pharmacists identified a total of 388 medication discrepancies in 161 patients; 16% of discrepancies were considered "unintentional." Twenty-five discharging patients were identified for enrollment in medication management services, with 20 of these patients enrolling in all 3 services (medication delivery, synchronization, and medication packaging). The P2PDS increased community pharmacist confidence in discharge medication filling (40% vs. 95%, P < 0.001) and increased the percent of patients receiving community pharmacist medication reconciliation (14%-76%, P < 0.001).
Enhancing pharmacist communication across practice settings with a P2PDS decreases care fragmentation through identification of medication discrepancies and improves pharmacist confidence in patient care provision.
社区药剂师通常是患者出院后首先接触到的医疗专业人员，但很少提供相关的出院信息。
实施药剂师到药剂师的出院总结（P2PDS），以提高药师为从医院过渡回家的患者提供护理的安全性。
学术医疗中心的住院药剂师进行出院药物重整，并将出院电子处方发送至配药药房。
进行了一项多学科的系统间质量改进项目，以证明通过 P2PDS 向社区药剂师共享临床信息的影响。
在社区药剂师的参与下，在整个医疗系统的住院病房创建并实施了 P2PDS。评估的结果包括识别药物差异、参与可报销的药物管理服务以及药剂师在填写出院处方时的信心。
在研究期间，社区药剂师在 161 名患者中总共发现了 388 种药物差异；其中 16%的差异被认为是“非故意的”。确定了 25 名出院患者参加药物管理服务，其中 20 名患者参加了所有 3 项服务（药物输送、同步和药物包装）。P2PDS 增加了社区药剂师对出院药物配药的信心（40%对 95%，P<0.001），并增加了接受社区药剂师药物重整的患者比例（14%-76%，P<0.001）。
通过 P2PDS 增强了实践环境中药剂师之间的沟通，通过识别药物差异减少了护理的碎片化，并提高了药剂师对患者护理提供的信心。
