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Pharmacists’ involvement in discharge summaries at The Alfred Hospital
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
2015 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Introduction: The point of discharge from the hospital poses a high risk for medication errors due to incorrect or incomplete transfer of medical information between care providers. At The Alfred Hospital, the use of a standardized discharge summary template and clinical pharmacy services including medication reconciliation and discharge counseling contributes to minimize medication errors on discharge. Aim: To evaluate pharmacists’ involvement in discharge summaries at The Alfred Hospital and evaluate the impact of a new discharge summary template. Materials and Methods: Retrospective comparison of discharge summaries written by pharmacists and doctors in 2015, and doctors in 2014 and 2015 at The Alfred Hospital. Accuracy of discharge summary, comments to GPs and accuracy of medication list was compared. Results: The discharge summary was accurate in 74.8 % of 147 and 48.1 % of 131 discharge summaries written by pharmacists and doctors, respectively, and there was a comment to the GP in 98.6 % and 81.7 %, respectively. Accurate documentation of new, ceased and changed medications was found in 75.6 %, 48.3 % and 88.9 % in the pharmacist group and 44.0 %, 11.3 % and 60.0 % in the doctor group. In 2014, 28.0 % of 75 discharge summaries written by doctors were accurate and 50.7 % had a comment to the GP. Documentation of new, ceased and changed medications was accurate in 68.3 %, 16.3 % and 19.0 % of discharge summaries from 2014, respectively. Conclusion: Medication information on discharge is more accurate and complete and more commonly includes a relevant comment to the GP if the discharge summary is completed by a pharmacist. The new template contributed to more accurate discharge summaries and higher frequency of comments to the GP. To further minimize medication errors, education and evaluation of pharmacists’ involvement in the discharge summary process should be prioritized.

Place, publisher, year, edition, pages
2015. , 34 p.
Keyword [en]
discharge summary
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-261674OAI: oai:DiVA.org:uu-261674DiVA: diva2:850930
Subject / course
Educational program
Master of Science Programme in Pharmacy
Available from: 2015-09-04 Created: 2015-09-02 Last updated: 2015-09-04Bibliographically approved

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