Evaluation of the pharmacist role in discharge from hospital

When patients are discharged from hospital it is vital that the information regarding their medication is provided to the General Practitioner (GP) as accurately and efficiently as possible. However errors frequently occur and the NHS is currently investigating how to improve discharge systems, one approach is to use pharmacists to write discharge prescriptions or To Take Out (TTOs). The aim of the audit was to compare discrepancies on TTOs (To take out) between different transcribers: doctors, pharmacists and nurses and identify factors which are predictors of discharge discrepancies. Discharge summaries written by different transcriber groups from three study wards at one hospital were selected. Discrepancies were identified by comparing the unauthorised TTO (TTO prior to final pharmacy check) to authorised TTOs, medical notes and prescription chart. Discrepancies were classified according to the CHUMS classification procedure. Logistic regression was used to identify predictors of discrepancies. Two hundred and fifteen TTOs were included in the audit written by pharmacists, doctors and nurses (n= 85, 81 and 49, respectively). Nearly 50% of TTOs contained at least one discrepancy, the most common of which was omission of a medicine. The significant predictors of discrepancies were if a TTO was written by a nurse or a doctor or if there was more than three hours between an unauthorised TTO being authorised (Odds ratios were 3.45, 2.26 and 3.88, respectively). Overall this study demonstrates the using pharmacist transcribers is at least as safe as previous systems and is unlikely to introduce additional discrepancies. Alternative approaches which support the healthcare team to work closer together at the time of discharge should reduce delays authorising the TTO and reduce discrepancies

Identifying Outcomes of Care from Medical Records to Improve Doctor-Patient Communication

Between appointments, healthcare providers have limited interaction with their patients, but patients have similar patterns of care. Medications have common side effects; injuries have an expected healing time; and so on. By modeling patient interventions with outcomes, healthcare systems can equip providers with better feedback. In this work, we present a pipeline for analyzing medical records according to an ontology directed at allowing closed-loop feedback between medical encounters. Working with medical data from multiple domains, we use a combination of data processing, machine learning, and clinical expertise to extract knowledge from patient records. While our current focus is on technique, the ultimate goal of this research is to inform development of a system using these models to provide knowledge-driven clinical decision-making

Characterising the nature of primary care patient safety incident reports in the England and Wales National Reporting and Learning System: a mixed-methods agenda-setting study for general practice

Background There is an emerging interest in the inadvertent harm caused to patients by the provision of primary health-care services. To date (up to 2015), there has been limited research interest and few policy directives focused on patient safety in primary care. In 2003, a major investment was made in the National Reporting and Learning System to better understand patient safety incidents occurring in England and Wales. This is now the largest repository of patient safety incidents in the world. Over 40,000 safety incident reports have arisen from general practice. These have never been systematically analysed, and a key challenge to exploiting these data has been the largely unstructured, free-text data. Aims To characterise the nature and range of incidents reported from general practice in England and Wales (2005–13) in order to identify the most frequent and most harmful patient safety incidents, and relevant contributory issues, to inform recommendations for improving the safety of primary care provision in key strategic areas. Methods We undertook a cross-sectional mixed-methods evaluation of general practice patient safety incident reports. We developed our own classification (coding) system using an iterative approach to describe the incident, contributory factors and incident outcomes. Exploratory data analysis methods with subsequent thematic analysis was undertaken to identify the most harmful and most frequent incident types, and the underlying contributory themes. The study team discussed quantitative and qualitative analyses, and vignette examples, to propose recommendations for practice. Main findings We have identified considerable variation in reporting culture across England and Wales between organisations. Two-thirds of all reports did not describe explicit reasons about why an incident occurred. Diagnosis- and assessment-related incidents described the highest proportion of harm to patients; over three-quarters of these reports (79%) described a harmful outcome, and half of the total reports described serious harm or death (n = 366, 50%). Nine hundred and ninety-six reports described serious harm or death of a patient. Four main contributory themes underpinned serious harm- and death-related incidents: (1) communication errors in the referral and discharge of patients; (2) physician decision-making; (3) unfamiliar symptom presentation and inadequate administration delaying cancer diagnoses; and (4) delayed management or mismanagement following failures to recognise signs of clinical (medical, surgical and mental health) deterioration. Conclusions Although there are recognised limitations of safety-reporting system data, this study has generated hypotheses, through an inductive process, that now require development and testing through future research and improvement efforts in clinical practice. Cross-cutting priority recommendations include maximising opportunities to learn from patient safety incidents; building information technology infrastructure to enable details of all health-care encounters to be recorded in one system; developing and testing methods to identify and manage vulnerable patients at risk of deterioration, unscheduled hospital admission or readmission following discharge from hospital; and identifying ways patients, parents and carers can help prevent safety incidents. Further work must now involve a wider characterisation of reports contributed by the rest of the primary care disciplines (pharmacy, midwifery, health visiting, nursing and dentistry), include scoping reviews to identify interventions and improvement initiatives that address priority recommendations, and continue to advance the methods used to generate learning from safety reports