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Audit of Pharmacist-prepared Immediate Discharge Summaries (IDS)Maire McManus & Dianne Gill; Pharmacy, Antrim Area Hospital, Northern Health and Social Care Trust
Allison Loomie ; Pharmacy, Causeway Hospital, Northern Health and Social Care Trust
IntroductionThe Guidelines and Audit Implementation Network (GAIN) Guidelines on Regional Immediate Discharge Documentation for patients being discharged from Secondary into Primary Care¹ were published in June 2011 and contain essential information required by GPs on the Immediate Discharge Summaries (IDS).
In Antrim Area hospital, Pharmacist Independent Prescribers and Clinical pharmacists, Band 7 or above who have completed an in-house trainingprogramme, are authorised to prepare the discharge medication section of the IDS. Medical staff complete the clinical narrative in Part 1 of the IDS template and, if an authorised pharmacist is available, the pharmacist will complete the medication section IDS Part 2 template. Both parts of the IDS are then given to the patient to take to the GP practice on discharge.
The pharmacist who is preparing the IDS Part 2 will firstly completea medicines reconciliation and perform a clinical check on the discharge medication before completing a transcription check with another pharmacist or authorised pharmacy technician, prior to the prescription being dispensed.
Aims & ObjectivesTo audit pharmacist-prepared IDS Part 2 templates against pre-determined standards to ensure they contain all the necessary information required to comply with the Trust protocol and GAIN guidelines 2011.
MethodA senior clinical pharmacist completed a pre-designed data collection form on a random selection of 60 IDS, prepared by 16 clinical pharmacists, on 10 medical wards in Antrim Area Hospital.
There were 26 audit standards and 38 other criteria audited to ensure that clinical pharmacist-prepared IDS contained all the necessary information required by GPs to follow-up their patients in primary care and to audit if pharmacists were working within the Trust protocol.
Data collection took place over 2 weeks, between 16th and 27th June 2014, and IDS prepared on different weekdays, including Mondays and Fridays, were audited. The clinical pharmacists were not aware of the audit taking place. Medical notes containing the medicine kardex, medicines reconciliation form and IDS were reviewed and laboratory results were checked. A validation check was independently completed, on a sample of 14 IDS (7 with problems identified), by a senior clinical pharmacist from another hospital in the Northern Trust using the same data collection form.
ResultsTranscription of medication from the medicine kardex to the IDS by the clinical pharmacist was 100% accurate in terms of drug name, formulation, strengthand frequency. On occasion, there were minor inaccuracies for example, metformin was not specified with breakfast. A 1.3% error rate/prescribed medication or 0.15 errors per IDS was found (see table below).
*These errors may have been discussed with the prescriber and deemed appropriate but this was not documented.
Most of these medicines / combinations were prescribed prior to admission.
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69% of the audit criteria standards were met. The table below shows a sample of standards met and a couple that need further work.
DiscussionAll pharmacists are working within the Trust protocol which ensures that correct procedures are being adhered to. This audit demonstrates the excellent quality of information provided to GPs by Clinical pharmacists on the IDS Part 2 template.
The IDS Part 2 template was designed by pharmacists using the 2011 GAIN guidelines. The Writemed medicines reconciliation software has improved discharge information because it ensures that all the information required by GPs is recorded by the pharmacist completing the medicines reconciliation on discharge and appears on the IDS Part 2 template.Monitoring requirements may need to be reviewed more closely. More than half of the IDS prepared needed the GP to monitor the patient post-discharge as a result of their medication changes.
ConclusionTranscription of medication onto the IDS by clinical pharmacists is accurate. Error rate 0% for drug name, formulation, strength and frequency.
A second clinical check by another pharmacist is not required which allows accredited checking technicians to complete the checking process, freeing up pharmacist time to complete more Medicines Reconciliation.
Vast improvements have been made in the quality of information provided to GPs on the IDS and this was fed back by a GP representative at a recent interface meeting.
Areas for improvement include product standardisation, monitoring requirements and baseline test results.
Clinical pharmacists have been reminded to document discussions with prescribers about potential problems identified with medicines.
Re-audit is planned for June 2016.
Reference1. Guidelines on Regional Immediate Discharge Documentation for patients being discharged from Secondary into Primary Care. GAIN. June 2011
Description of errors
Ranitidine co-prescribed with omeprazole*
Simvastatin 40mg + verapamil - increased risk of myopathy*
Clopidogrel + aspirin - no stop date for clopidogrel*
Nitrofurantoin and eGFR 33 - ineffective*
Aranesp® & venofer® SC but should have been IV
Colchicine & simvastatin increased risk of myopathy*
Ciprofloxacin with calcium carbonate and ferrous fumarate - reduced absorption
Inhaler prescribed with route of administration oral
Administration time missing for warfarin
Audit Criteria Standard % 2014 %
Prescription is legible 100 100
All drug names are stated 100 100
All formulations are stated 100 100
All strengths of medicines are stated 100 100
All frequencies are stated 100 100
When appropriate reducing dose is detailed 100 100
When appropriate night sedation 100 100is discontinued
Product choice is in line with DHSSPS 70 67Pharmaceutical Clinical Effectiveness policies
Monitoring arrangements are appropriate 100 80
a
a
b
b
