Structure and Content of Drug Monitoring Advices Included in Discharge Letters at Interfaces of Care: Exploratory Analysis Preceding Database Development

Benedict Morath; Katharina Wien; Torsten Hoppe-Tichy; Walter Emil Haefeli; Hanna Marita Seidling

doi:10.2196/10832

Structure and Content of Drug Monitoring Advices Included in Discharge Letters at Interfaces of Care: Exploratory Analysis Preceding Database Development

JMIR Med Inform. 2019 Apr 8;7(2):e10832. doi: 10.2196/10832.

Authors

Benedict Morath^{1

2

3}, Katharina Wien^{1

2}, Torsten Hoppe-Tichy^{2

3}, Walter Emil Haefeli^{1

2}, Hanna Marita Seidling^{1

2}

Affiliations

¹ Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
² Cooperation Unit Clinical Pharmacy, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
³ Hospital Pharmacy, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.

PMID: 30958278
PMCID: PMC6475819
DOI: 10.2196/10832

Abstract

Background: Inadequate drug monitoring of drug therapy after hospital discharge facilitates adverse drug events and preventable hospital readmissions.

Objective: This study aimed to analyze the structure and content of drug monitoring advices of a representative sample of discharge letters as a basis for future electronic information systems.

Methods: On 2 days in November 2016, all discharge letters of 3 departments of a university hospital were extracted from the hospital information system. The frequency, content, and structure of drug monitoring advices in discharge letters were investigated and compared with the theoretical monitoring requirements expressed in the corresponding summaries of product characteristics (SmPC). The quality of the drug monitoring advices in the discharge letters was rated with the domains of an adapted systematic instructions for monitoring (SIM) score.

Results: In total, 154 discharge letters were analyzed containing 1180 brands (240 active pharmaceutical substances), of which 50.42% (595/1180) could theoretically be amended with a monitoring advice according to the SmPC. In reality, 40 discharge letters (26.0%, 40/154) contained a total of 66 monitoring advices for 57 brands (4.83%, 57/1180), comprising 18 different monitoring parameters. Drug monitoring advices only addressed mean 1.9 (SD 0.8) of the 7 domains of the SIM score and frequently did not address reasons for monitoring (86%, 57/66), the timing of monitoring, that is, the start (76%, 50/66), the frequency (94%, 63/66), the stop (95%, 63/66), and how to react (83%, 55/66).

Conclusions: Drug monitoring advices were mostly absent in discharge letters and a gold standard for appropriate drug monitoring advices was lacking. Hence, more effort should be put in the development of tools that facilitate easy presentation of clinically meaningful drug monitoring advices at the point of care.

Keywords: drug monitoring; patient discharge summaries; transition of care.

©Benedict Morath, Katharina Wien, Torsten Hoppe-Tichy, Walter Emil Haefeli, Hanna Marita Seidling. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 08.04.2019.