Admission to Discharge: Development of a Seamless Discharge Prescription Form

In April 2005, Leamington District Memorial Hospital announced the hospitalwide implementation of a seamless discharge prescription (SDRx) form. Developed over 2 years of research and supported by the results of a successful pilot project, the SDRx form is a paper-based tool for the documentation of medications at the time of admission to and discharge from this 88-bed community hospital. The form becomes the patient’s discharge prescription and is also distributed to all of his or her health care providers as a way of providing current medication information on discharge. The SDRx form was created in response to a recommendation arising from the Canadian Council on Health Services Accreditation (now known as Accreditation Canada) survey of the hospital in November 2003, which stated that the family physician should receive, at the time of discharge, information about the patient’s stay in hospital. The development and implementation of the SDRx form predated the intense rise of interest in medication reconciliation1 in Canada, which began in 2005 and 2006 with the Safer Healthcare Now! campaign to improve patient safety in the Canadian health care system.2 The ultimate goal of medication reconciliation is the prevention of adverse drug events at all transition points in the patient’s care. Development of the SDRx was Leamington Hospital’s first step toward implementing medication reconciliation and supports the concept of seamless care.3-5 Barriers to seamless care have been documented in a multitude of published articles.5-7 Lack of communication between sites of care, the need for patient confidentiality and consent, and constraints of time and money are universal concerns.5 Three of the major challenges that Leamington Hospital faced in complying with the accreditation survey recommendation were (1) lack of hospital privileges and timely accessibility to patient information for family physicians, (2) patients’ lack of access to family physicians because of a regional physician shortage,8,9 and (3) lack of communication of complete and accurate medication information to physicians and pharmacists in the community at discharge. The occurrence of adverse events soon after admission to hospital and after discharge has been well documented,6,10,11 and efforts to prevent these adverse effects are important factors in increasing patient safety and the quality of care. Among elderly patients, almost 50% of preadmission medications are changed before discharge,5 and up to one-half of elderly patients discharged from hospital are readmitted within 1 month as a result of medication-related problems.5 Given these statistics and the aging of the population, preventable adverse drug events may occur because of medicationrelated discrepancies. Errors that can be prevented by reconciling medications include but are not limited to inadvertent omission of needed home medications, failure to restart home medications following transfer and discharge, duplicate therapy at discharge (as a result of brand and generic combinations or formulary substitutions), and errors associated with incorrect doses or dosage forms on medication orders.12 These discrepancies represent dangerous gaps in the collection of medication information that can occur when a patient is admitted to hospital and that may continue through to discharge. The goal in developing the SDRx form was to improve the accuracy of both the initial medication list and the discharge medication list by connecting the 2 processes.