Bergkvist
(2009) / Sweden
|
Pre-Post
|
84 (6.2) / 84 (6.7)
71.2 / 60.3
|
115
|
Medication reconciliation done at hospital admission (pharmacist),
creation of a systematic medication care plan, updated continuously
(care team), patient information and education based on specially
developed drug information leaflets (pharmacist), discharge summary
(physician) checked by the pharmacist,
reconciliation\adjustment through discussion with the
physician before the patient’s discharge.
Discharge summary, carefully checked and approved by both
pharmacist and physician
|
2, 4
|
Boockvar
(2006) / United States
|
Pre-Post
|
84.4 (8.8) / 83.9 (10.3)
78.2 / 82.7
|
168
|
Medication reconciliation on patient discharge (pharmacist) charted on a
communication form and sent to the LTCF physician. The form becomes part
of the LTCF pharmacy record.
Communication form sent to the LTCF physician
|
2,4
|
Catic
(2013) / United States
|
Pre-Post
(pilot study)
|
90 / 84.4
60 / 62.5
|
29
|
In-person/telephone meeting with the proxy within 24h of admission. A
pocket-sized printed booklet for decision support was given to all
proxies to provide standardized information. At discharge, a 1-page
report summarizing the consultation focusing on recommendations for
symptom control, goals of care, and advance care planning was sent to
the patient’s primary care providers. Two weeks post-discharge, the
proxy was telephoned for support and to review the patient’s health
status, advance care planning, decision making, and proxy needs.
Report sent to primary care providers
|
1 (palliative care nurse), 2 (geriatrician)
|
Crotty (2004) / Australia
|
Randomized controlled trial
|
82 / 83.4
58.9 / 63
|
110
|
On patient’s discharge, both the family physician and the community
pharmacist were faxed a medication transfer summary compiled by the
transition pharmacist. This communication included specific information
on changes in medications that had been made in file hospital and
aspects of medication management that required monitoring. The
transition pharmacist also coordinated a case conference with the family
physician, community pharmacist, and a registered nurse at the facility,
to give information concerning medication use and appropriateness.
Communication form (discharge supplemental information on
medications) sent to family physician and community pharmacist, case
conference
|
2,4
|
Elliott
(2012) / Australia
|
Pre-Post
|
84 (median) / 84 (median)
62.8 / 58.9
|
428
|
A 7-day residential care medication administration chart (IRCMAC) was
prepared (hospital pharmacist). The IRCMAC, photocopy of the discharge
prescriptions and instructions for using the IRCMAC were was placed with
the discharge medications and transported with the patient. The
pharmacist telephoned the RCF prior to discharge to notify them that an
IRCMAC would be provided.
Communication form (IRCMAC) sent to the LTCF, phone call prior
discharge to notify
|
4
|
Gregersen
(2011) / Denmark
|
Non-randomized trial
|
88 (2 intervention groups combined)
tailored group = 83% / standardized group = 68%
|
238
|
Early discharge planning and in-hospital assessments, 2 post-discharge
follow-up visits (or more in the tailored group), discharge summary sent
to GP.
Discharge summary sent to GP
|
1, 2, 3
|
Harvey
(2014) / Australia
|
Randomized controlled trial
|
83.8 (7) / 86.7 (7)
66.7 / 59.3
|
116
|
Tailored care plan development and in-hospital assessments, with
possibility of additional visits as required, education and support to
the LTCF staff and the GP.
”[E]ducation and support” of the GP
|
1 (aged care nurse), 2 (geriatrician)
|
Jacobs
(2011) / United States
|
Pre-Post (quality improvement initiative)
|
not reported/ no control group
not reported / no control group
|
not reported
|
Letter sent to the LTCF with contact information, phone contact with the
LTCF facility within 2 days of discharge and review of the discharge
orders, confirmation that the patient will see a doctor within 5 days.
Letter sent to the LTCF, phone call
|
1 (heart failure nurse, RN care coordinator)
|
Midlov
(2012) / Sweden
|
Pre-Post
|
period1: 84.4 (65-99)/ period2: 85.6 (69-102)/ period 3: 85.1 (66-95) /
no control group
period1: 74%/ period2: 81%/ period3: 68% / no control
group
|
123
|
Patient education and LIMM discharge information form. Medication
reconciliation upon admission of the patient (clinical pharmacist) and
review and monitoring of medication during hospital stay according to
the LIMM-model. LIMM quality control forms for discharge medication
reconciliation, performed by pharmacist who gives suggestions for
changes/corrections to the physician before patient discharge Medication
list, general information and report written by the physician, discussed
at discharge and sent to the GP
Discharge form sent to the GP
|
2,4
|
Ward
(2008) / United States
|
Non-randomized trial
(quality improvement initiative)
|
85.6 (no sd) / 78.6 (no sd)
Cumulative mean age (both groups) = 83.0 (9.22)
50 / 60
|
20
|
LTCF specific communication form for discharge instructions and
medication list, transmitted before discharge instead of with the
patient - allowing contact with pharmacist before discharge
LTCF specific communication form (so that nurses won’t have to
enter it in the charts, already in the right format), transmitted before
discharge instead of with the patient (so that the staff has the time to
order medication before the patient’s arrival)
|
1,2
|
Zafirau
(2012) / United States
|
Pre-Post (quality improvement initiative)
|
76 / 72.8
53.9 / 50
|
247
|
New standardized transfer form and education about its use.
Standardized transfer form used between the acute care and the
LTCF
|
1, 5 (LTCF staff, director of nursing)
|