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Example: (photons AND downconversion) - pump [search contains both "photons" and "downconversion" but not "pump"] It’s also popular on Influenster, where one reviewer shares, “ I am an active self-tan user, and this is one of my favorite self-tanners ever, especially for the price. The color is olive, so you don’t get an orangey tan but a natural, glowing-looking tan.” Many strategies to improve the quality of medication information in discharge summaries have been trialed, including guidelines, performance indicators, physician education and discharge summary templates with specific sections for medication information [ 3, 8, 15]. However, poor quality of discharge medication information persists [ 1, 4, 8, 16]. Electronic discharge summaries (EDSs) have the potential to improve the accuracy of discharge summary data, especially if they are integrated with electronic prescribing systems, but studies comparing EDSs with handwritten discharge summaries have produced variable results [ 17]. Several studies evaluating the accuracy of EDSs have reported high levels of missing or inaccurate information [ 10, 16, 18]. For example, our group evaluated an EDS in which discharge medication lists were imported from the hospital’s e-prescription record, and medication changes were manually typed [ 10]. We found that 59% of EDS had medication list discrepancies, and only 34% of clinically significant medication changes were explained [ 10]. Medication list discrepancies occurred when, for example, over-the-counter medicines were not included on the discharge prescription, medication changes were made in the e-prescribing system after the EDS was prepared, or amendments were made on the paper copy of the e-prescription that was sent to the hospital pharmacy for dispensing [ 10]. Similarly, an Australian study by Gilbert et al. reported medication list discrepancies in 31% of EDSs and no reporting of reasons for medication changes despite there being a ‘medication changes’ table in the EDS template [ 16]. It is important to provide both an accurate medication list and explanations for medication changes made in hospital. No studies to our knowledge have evaluated the impact of pharmacists on both of these outcomes, nor the sustainability of pharmacist discharge summary interventions. Contributing to medical discharge summaries adds to pharmacists’ workload, and whilst improvement may be observed in short-term intervention studies, it is important to know whether these can be sustained in a busy hospital environment and with staff turnover.
Join us for a continuing education event hosted by Accanto Health and presented by Anna B. Tanner, MD, FAAP, FSAHM, CEDS-S, and Leah L. Graves, RDN, LDN, CEDRD-S, FAED. There is no fee to attend this course. Unlike most previous studies that only assessed the accuracy of discharge medication lists [ 18, 22, 23], this study demonstrated additional benefits in terms of an improvement in communication of medication changes that were made in hospital. Communication of medication changes is critical at times of transition of care. A common complaint from primary care physicians is that medication changes are often not stated or explained in discharge summaries [ 26]. Failure to mention changes makes it difficult for the primary care physician to know whether they were intentional or accidental, and failure to explain the reasons for medication changes makes it difficult for them to know whether to re-start a ceased medication, whether to continue a new medication, whether to titrate the dose, what the treatment goal is and what outcomes to monitor. This is particularly relevant in cases where the reason(s) may not be obvious [ 24]. Shuman AG, Barnosky AR, Koopmann CF (2012) Implementation of ethics grand rounds in an otolaryngology department. Laryngoscope 122:271–274 Kinzl JF, Traweger C, Biebl W et al (2006) Burnout und Belastungsstörungen bei Intensivmedizinern. Dtsch Med Wochenschr 131:2461–2464A recent commentary from two Australian physicians questioned the exclusive use of pharmacists to prepare medication information in medical discharge summaries [ 36], citing concerns about isolating medication reconciliation from other aspects of the medical discharge plan and the fact that not all discharges occur within pharmacist working hours. However, they went on to highlight the importance of involving pharmacists in medical teams to support physicians to ensure accurate information in discharge summaries, which is consistent with our model in which pharmacists and physicians collaborated to prepare EDS medication information. Palda VA, Bowman KW, McLean RF, Chapman MG (2005) „Futile“ care: do we provide it? Why? A semistructured, Canada-wide survey of intensive care unit doctors and nurses. J Crit Care 20:207–213 Specify at least one medical complication of ARFID that may indicate need for intensive medical/nutritional support. Kooij FO, Klok T, Hollmann MW et al (2008) Decision support increases guideline adherence for prescribing postoperative nausea and vomiting prophylaxis. Anesth Analg 106:893–898 Reiter-Theil S, Mertz M, Schurmann J et al (2011) Evidence – competence – discourse: the theoretical framework of the multi-centre clinical ethics support project METAP. Bioethics 25:403–412
Yemm R, Bhattacharya D, Wright D, Poland F. What constitutes a high quality discharge summary? A comparison between the views of secondary and primary care doctors. Int J Med Educ. 2014;5:125–31. Marshall WA, Tanner JM (February 1970). "Variations in the pattern of pubertal changes in boys". Arch. Dis. Child. 45 (239): 13–23. doi: 10.1136/adc.45.239.13. PMC 2020414. PMID 5440182. Qaseem A, Forland F, Macbeth F et al (2012) Guidelines International Network: toward international standards for clinical practice guidelines. Ann Intern Med 156:525–531 Cottone RR, Claus RE (2000) Ethical decision-making models: a review of the literature. J Couns Dev 78:275–283
Devlin B, Magill G (2006) The process of ethical decision making. Best Pract Res Clin Anaesthesiol 20:493–506 Schwarz CM, Hoffmann M, Schwarz P, Kamolz LP, Brunner G, Sendlhofer G. A systematic literature review and narrative synthesis on the risks of medical discharge letters for patients’ safety. BMC Health Serv Res. 2019;19(1):158. Albisser Schleger H, Pargger H, Reiter-Theil S (2008) „Futility“ – Übertherapie am Lebensende? Gründe für ausbleibende Therapiebegrenzung in Geriatrie und Intensivmedizin. Z Palliativmed 9:67–75 Elliott RA, Tan Y, Chan V, Richardson B, Tanner F, Dorevitch MI. Pharmacist-physician collaboration to improve the accuracy of medication information in electronic medical discharge summaries: effectiveness and sustainability. Pharmacy (Basel). 2020;8(10):2.
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