An audit of discharge medicines counselling on an acute elderly admissions unit
Authors: Dar A , Mitchell-Gears S 
Published: November 2022

Abstract

Introduction
Poor discharge communication is a major contributor to medication-related errors during care transfers. The World Health Organisation 2019 Medication Safety report1 acknowledged this and recommended prioritising collaboration with patients/families/carers, communicating medication changes, and interdisciplinary working. The Care Quality Commission 2020 National Patient Inpatient Survey found that only 28% of participants received information regarding side-effects, 55% given explanations on medicines-use, 48% provided written information and 12% no information.2. Health information systems including Medicines a Patient Profile Summary (MaPPs) provide easy-read leaflets which may improve patient awareness and understanding of their medicines.3 This study explored patients’ experience of DMC at one hospital Trust.

Aim
To measure patient satisfaction and understanding of DMC offered at Mid Yorkshire Hospitals Trust and establish whether the Trust standards were met of all patients with medication changes (new/stopped/changed) receiving verbal DMC and being offered a MaPPs leaflets/charts documenting the changes.

Method
Ethics approval was not required for this service evaluation. Baseline data was collected from the Trust Medicines Information department to establish which ward had the most discharge enquiries in October 2021. Inpatients from this ward were included if they were elderly, had a previous admission within the last 2 months, usually lived at home and managed their own medications or had help from relatives/friends. Inpatients were excluded if they were care-homes residents, had carers who visited to administer medicines, used a compliance aid or had no medication changes. A 13-item questionnaire was designed for qualitative/quantitative data collection over a 4-week period in December 2021. Questions concerned discharge medicines information provided (written/verbal), patient/relative satisfaction and patient/relative understanding of medicines indicated and changes. Quantitative data underwent descriptive statistical analysis, whilst qualitative data were grouped by similarity and frequency counted.

Results
A total of 20 elderly patients/relatives were included: 11 were female and 9 were male. Eight respondents (40%) reported not receiving written information. Twelve respondents (60%) reported received a SystmOne discharge letter, of whom 7 received additional written information that included a discharge medication list. This was provided by nurses on all occasions. No respondents reported being offered a MaPPs leaflet/chart, but 17 respondents indicated that they thought that a MaPPs leaflets/chart would have been beneficial. Eleven respondents reported receiving verbal DMC, of whom 4 rated themselves as being “not very satisfied” with it. Key themes were: ‘rushed discharges’, ‘limited patient/relative involvement’. No respondents reported being informed about side-effects. Eleven and 14 respondents respectively reported partially/not fully understanding why medications were indicated or changes made.

Discussion/Conclusion
Overall, DMC was below the Trust standards. Poor explanation of changes and no information on side-effects was common practice. The findings are limited by the small sample size and limited generalisability to ethnic minorities. Future study plans include involving underrepresented patient groups in a larger sample. Nevertheless, the following recommendations were made: Offer all patients MaPPs leaflets/reminder charts and verbal DMC; Offer all elderly ward nurses pharmacy-led MaPPs training; add monthly reminders during morning handovers to use MaPPs; Document on the electronic prescribing system when MaPPs leaflets are provided.

References
1. Medication Without Harm [online]. World Health Organisation.2019 [accessed:07/04/22]. Available from: https://www.who.int/initiatives/medication-without-harm
2. Adult inpatient survey | Care Quality Commission [online].2020 [accessed:07/04/22]. Available from: https://www.cqc.org.uk/publications/surveys/adult-inpatient-survey-2020
3. Introducing MaPPs Patient-Friendly, Personalised Medicines Information [online]. Medicines: a Patient Profile Summary. [accessed:07/04/22]. Available from: https://www.mappsorg.com/