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London Transfer Project: Reducing Medication Incidents After Discharge From Hospital to Long-term Care.

Abstract：

BACKGROUND:Long-term care (LTC) homes expressed concern that patients had experienced medication incidents after hospital discharge as a result of poor coordination of care. OBJECTIVE:The London Transfer Project aimed to reduce LTC medication incidents by 50% within 48 hours of discharge from general medicine units at the London Health Sciences Centre. DESIGN:This quality improvement study involved 2 hospitals and 5 LTC homes in London, Ontario, Canada. The baseline prevalence of medication incidents was measured and explored for root causes. Two change ideas were tested on general medicine units to improve transfer communication: (1) expediting medication reconciliation and (2) faxing medication plans before discharge. MEASURES:Evaluation involved time-series measurement and a comparison of baseline and intervention periods. The primary outcome was medication incidents by omission or commission within 48 hours of discharge, which was determined by dual chart reviews in hospital and LTC homes. Process measures included medication reconciliation and fax completion times. Hospital discharge times were included as a balance measure of the new communication process. RESULTS:Four hundred seventy-seven LTC transfers were reviewed between 2016 and 2017; 92 transfers were reviewed for medication incidents in participating homes at baseline (January-April 2016) and implementation (January-April 2017). Medication incidents decreased significantly by 56%, from 44% (22/50) at baseline to 19% (8/42) during implementation (P = .006). Medication reconciliation completion by noon increased from 56% (28/50) to 74% (31/42) but not significantly (P = .076). Faxes sent before discharge increased significantly from 4% (2/50) to 67% (28/42, P = .015). There was no significant change in hospital discharge time. CONCLUSIONS/IMPLICATIONS:Medication incidents can be significantly reduced during care transitions by taking a systems perspective to explore quality gaps and redesign communication processes. This solution will be scaled to other inpatient services with a high proportion of LTC residents.

journal_name

J Am Med Dir Assoc

journal_title

Journal of the American Medical Directors Association

authors

Carson J,Gottheil S,Lawson S,Rice T

doi

10.1016/j.jamda.2018.09.037

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

481-486

issue

eissn

1525-8610

issn

1538-9375

pii

S1525-8610(18)30552-8

journal_volume

pub_type

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London Transfer Project: Reducing Medication Incidents After Discharge From Hospital to Long-term Care.