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| Patient medications Care Quality Commission calls for better information sharing |
| Email your comments The Care Quality Commission’s (CQC) calls for better information sharing on patient medications comes after a CQC survey published on 27 October on the CQC website7. The survey found that information shared between GPs and hospitals, when a patient moves between services, is often “patchy, incomplete and not shared quickly enough”, increasing the risk of medication related patient safety incidents. The survey of 280 GP practices found that almost a quarter are not systematically providing hospitals with information on previous drug reactions, and more than one in ten are not providing information on allergies when a patient is admitted to hospital. Additionally, 81 per cent of the GP practices surveyed said details of prescribed medicines contained in hospital discharge summaries were incomplete or inaccurate “all of the time” or “most of the time”. The evidence that medicines management is important at the primary/secondary care interface is clear, as is the evidence that in general, the systems in place for communication between primary and secondary care are inadequate. Adverse drug events account for 5 per cent of all hospital admissions1 and up to 30 per cent of hospital admission in older people2. Older people are at higher risk of adverse drug events (ADEs), drug-interactions and drug-disease interactions3-5 - because of age-related changes in pharmacokinetics and pharmacodynamics, and of course polypharmacy. Obtaining a reliable drug history is sometimes difficult in the acute care setting, as patients may not know what they are taking and may not have brought their medication or prescription with them – inevitable to some extent, given the urgent nature of their attendance. Accessing GP drug lists out of hours is pretty much impossible and even access during working hours can be a frustrating exercise. The reverse is also true – GPs find it difficult to obtain accurate information about prescribing from hospitals. Much of this reflects the broader issue of communication between primary and secondary care, which is so critical, especially for frail older patients who may be less able to communicate for themselves, for example because of dementia or stroke. A variety of schemes are in operation; for example, pharmacists may be actively involved in obtaining drug histories and checking off discharge letters. There are ‘Grab a bag’ schemes (where patients’ medication is placed in a large green bag by the ambulance crew and brought with the patient to hospital). Some areas have developed e-prescribing in hospital, which may improve internal prescribing, but this is not yet widespread, and as far as I am aware, does not link up with primary care prescribing records. There are initiatives aimed at improving the quality of prescribing – for example the STOPP/START scheme from Gallagher et al6. But ultimately, what is needed is a uniform system of communication between primary and secondary care, which is fast, reliable and contains useful information. Clinicians are clearly responsible for the quality of the information they add to patients’ records, but we also need to ensure that communication systems are fit for purpose. Maybe NPFiT holds some promise; although slow in widespread roll out, in areas where shared systems are working, it has proved helpful. Effective management of medicines will be a requirement of trusts’ registration with the CQC, which comes into force in April 2010. Simon Conroy References 1. Pirmohamed M, James S, Meakin S, et al. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004;329(7456):15-19.
BGS Newsletter, November 2009 |