Adherence to UK national guidance for discharge information: an audit in primary care

• Published in: British journal of clinical pharmacology Vol. 78; no. 6; pp. 1453 - 1464
• Main Authors: Hammad, Eman A., Wright, David John, Walton, Christine, Nunney, Ian, Bhattacharya, Debi
• Format: Journal Article
• Language: English
• Published: England BlackWell Publishing Ltd 01-12-2014
• Subjects: Adult; Aged; Aged, 80 and over; care transition; discharge communication; discharge information; discharge summary; Female; Guideline Adherence; Humans; Male; Medical Audit; medicine reconciliation; Middle Aged; NPC minimum dataset; Patient Discharge - standards; Pharmacoepidemiology; Primary Health Care; United Kingdom; care transition; NPC minimum dataset; medicine reconciliation; discharge information; discharge communication; discharge summary
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.12463

Aims
Poor communication of clinical information between healthcare settings is associated with patient harm. In 2008, the UK National Prescribing Centre (NPC) issued guidance regarding the minimum information to be communicated upon hospital discharge. This study evaluates the extent of adherence to this guidance and identifies predictors of adherence.
Methods
This was an audit of discharge summaries received by medical practices in one UK primary care trust of patients hospitalized for 24 h or longer. Each discharge summary was scored against the applicable NPC criteria which were organized into: ‘patient, admission and discharge’, ‘medicine’ and ‘therapy change’ information.
Results
Of 3444 discharge summaries audited, 2421 (70.3%) were from two teaching hospitals and 906 (26.3%) from three district hospitals. Unplanned admissions accounted for 2168 (63.0%) of the audit sample and 74.6% (2570) of discharge summaries were electronic. Mean (95% CI) adherence to the total NPC minimum dataset was 71.7% [70.2, 73.2]. Adherence to patient, admission and discharge information was 77.3% (95% CI 77.0, 77.7), 67.2% (95% CI 66.3, 68.2) for medicine information and 48.9% (95% CI 47.5, 50.3) for therapy change information. Allergy status, co‐morbidities, medication history and rationale for therapy change were the most frequent omissions. Predictors of adherence included quality of the discharge template, electronic discharge summaries and smaller numbers of prescribed medicines.
Conclusions
Despite clear guidance regarding the content of discharge information, omissions are frequent. Adherence to the NPC minimum dataset might be improved by using comprehensive electronic discharge templates and implementation of effective medicines reconciliation at both sides of the health interface.