Redefining the transfer medication management plan for subacute inpatients. A pilot study.
Aim: To develop a transfer medication management plan pro forma for subacute inpatients. Primary objective was to establish subacute clinicians’ current medication reconciliation workflow and identifying key components in the transfer medication management plan. Secondary objective was to identify clinicians’ barriers and enablers to medication reconciliation for subacute inpatients.
Methods: Mixed methods pilot study comprising a preliminary survey and focus group discussions, followed by rapid testing and feedback for the prototype. Geriatric and rehabilitation medicine consultants, advanced trainees and subacute pharmacists were recruited. The outcome of the survey and focus group informed the development of the transfer medication management prototype. Explanatory, descriptive statistics and thematic analysis of clinicians’ and pharmacists’ perspectives were generated.
Results: Eight advanced trainees, three pharmacists and one consultant were recruited. Pharmacists reported 100% of the components in the medication reconciliation form relevant to them compared to 30% reported by doctors. Nine participants (75%) reported missing information on admission to subacute. The commonest missed information were medication changes, duration of short-term medications, absence of an acute discharge summary or medication reconciliation completed by the discharging pharmacist. The themes for perceived barriers to medication reconciliation on admission were education, formatting, hybrid systems and lack of time.
Conclusions: Many existing medication reconciliation forms and management plans remain pharmacist driven and one-directional. In this study, we identified factors impacting on transitions of care, and medication review and management needs of clinicians and pharmacists to develop a transfer medication management plan prototype.