10 * A RETROSPECTIVE SURVEY OF ELDERLY PATIENTS' DISCHARGE SUMMARIES: ARE INPATIENT MEDICATION CHANGES COMMUNICATED TO GPS?

Abstract

Background: 80% of over 75s take a prescribed medication, yet approximately 50% of these are taken incorrectly (M Zhang et al, BMJ, 2009, 338, pp a275)). Adverse drug events (ADE's) were the fourth most commonly reported type of incident to the National Patient Safety Agency. Patient discharge from secondary to primary care has been highlighted as a key ‘transition point’ in which prescription errors occur, with almost half of patients experiencing an error. The Care Quality Commission have identified that the quality of discharge summaries needs improvement.Sampling methods: A retrospective case note analysis of medical patients, aged over 75, discharged home from an acute hospital trust in a given week was performed to identify medication changes, and to ascertain if these changes were communicated to GPs.Results: 64 patients and 438 admission medications were identified, giving a mean number of drugs per patient of 6.81. At discharge the average prescription had undergone 1.43 changes. 49 patients had their prescriptions changed during admission (77%). Of these, 50 were cardiac drugs (54%). Only 21 discharge summaries were accurate (43%). When accurate, a reason for the changes was given on 18 summaries (86%). 3 patients were identified who had anticoagulation either started or stopped during admission. None of these were fully communicated to their GPs.Conclusions: Despite long standing recognition of the problems associated with polypharmacy, the number of medications prescribed to individuals is increasing by 3.5% a year (Department of Health statistics, June 2004). The causes are multi-factorial, but may reflect too much emphasis on target driven prescribing rather than individualised treatment goals. Hospital admission represents an opportunity to review medication, but this necessitates a seamless transition of care. This study highlights there is still work to be done before this is fully realised.