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Correspondence to Linda J Dodds, Medicines Use and Safety Division, East and South East England Specialist Pharmacy Services, Clinical Pharmacy Unit, Northwick Park Hospital, Watford Road, Harrow HA1 3UJ, UK; [email protected], [email protected]
Introduction
Concern about the quality of written discharge prescription communication and its impact on patient care has been expressed in the world literature for decades.1–6
Potential consequences of poor communication of medicines information at transfer of care from a hospital to another care setting include unintentional discontinuation of therapy, restarting withdrawn therapy, duplication of therapy and failure to optimise therapy (eg, by uptitration or review). All of these can lead to preventable adverse drug events (ADEs) resulting in further morbidity or even death, readmission or increased use of primary care resources.1 2 7–10
Schnipper et al8 reviewed 84 medical discharges and found that 30 days after discharge preventable ADEs had occurred in 11% of patients. Although not all ADEs were ascribed to deficiencies in discharge communication, they led to visits to the emergency department or readmission for 8% of discharges. Witherington et al9 followed up 108 consecutive patients who were readmitted within 28 days of discharge. Documentation of changes in medication was incomplete for two-thirds and readmission was attributed to medication for 38% of patients of which 61% were deemed preventable. Forster et al reviewed 400 consecutive patients discharged from a general medical service. Overall 76 (19%) suffered adverse events of which 66% were related to medicines. Ineffective communication was highlighted as a key issue, with particular deficiencies around information about changes to medication and follow-up care required.10
In England, concerns about the legibility and timing of discharge communication have been largely allayed in the last 5 years by the introduction of electronic discharge notifications and monitored contractual obligations which ensure discharge summaries (which include a medication list) are sent to the patient's primary care practitioner within 24 h. However, concerns about the completeness and accuracy of the medicines information remain. In 2011 the Royal Pharmaceutical Society (RPS) issued guidance on what medicines information should be communicated each time patients moved between care settings.11 The guidance was endorsed by medical and nursing professional bodies.
As part of a strategy to help implement the RPS guidance and improve the quality of written...