Enhancing medicine information handover at hospital discharge: Evaluation of a multifaceted intervention pilot trial

BACKGROUND: Hospital pharmacists and doctors should collaborate to prepare discharge medicine handover information and pharmacists and nurses in providing discharge medicine counselling. This pilot trial evaluated a multifaceted intervention that included training hospital doctors to record medicine changes, patient risk stratification, and collaborative doctor and pharmacist discharge medicine reconciliation to improve information handover. METHODS: A pilot study was undertaken at two hospitals in Queensland, Australia. Evaluation incorporated an audit of intervention patient discharge medicine information handover with a control cohort and a time-and-motion observation. Eligible general medicine patients ≥65 years were recruited over nine weeks; a randomisation process was followed to select the control group. We aimed to incorporate 50 intervention patient discharges in the audit. RESULTS: Most of the 52 intervention and 50 control patients were male (34/52, 65.5 %; 32/50, 64.0 %); average age was 78.6 (SD = 9.0) and 77.7 (SD = 9.3) years. Medicine reconciliation was completed at the time of discharge for 50/52 (96.2 %) of intervention and 34/50 (68.0 %) of control patients; more electronic discharge summaries of intervention patients included all medicines compared to control patients; pharmacists were involved in all intervention discharges compared to 90.0 % (45/50) of control discharges. Discharge summaries of intervention patients were sent to general practitioners within 4.3 days and 9.2 days for control patients. Time-and-motion observations showed that pharmacist discharge medicine information handover time was reduced by 32 min between intervention and control cohorts. CONCLUSION: Our study showed that the multifaceted intervention reduced the time required to complete discharge medicine handover information, facilitated patient discharge, and reduced the time-period of sending discharge summaries to general practitioners.