Many patients don't know their Dx or Rx at discharge

More than half of discharged hospital patients know neither their diagnosis nor the medications they have been prescribed. So concluded a study of patients released from a New York teaching hospital. The study, published by Mayo Clinic Proceedings in August, does not surprise Eric Coleman, M.D., who has studied the breakdowns in care as patients are moved from one setting to another. Coleman is associate professor of healthcare policy and research at the University of Colorado Denver and Health Sciences Center and consultant for the Joint Commission on Accreditation of Healthcare Organizations.

"Patients and their caregivers must shoulder the burden when hospital staff drops the ball, as they often do," Coleman said. "Pharmacists clearly have a leg up on the rest of us. A number of studies show that pharmacists can play an important role in patient education and medication reconciliation. The Joint Commission is starting to shine a very positive light in this area."

The reality of patient education is gloomy. State University of New York researchers found that just 42% of patients knew their diagnosis at discharge. Only 30% could name their discharge meds, and 14% could describe common side effects. "Although not all patients are noncompliant because of poor communication, this is probably the leading cause," said study coauthor Eli Friedman, M.D., SUNY Health Sciences Center, Brooklyn.

"We have been working in this area for more than a decade," Coleman said. "There is little effective communication or support for patients and their families or caregivers between care settings." An August report from ASHP found similar gaps across care settings.

"The entire healthcare community can and must do a better job of sharing information and coordinating care for our patients across all practice settings," said Caryn Bing, M.S., FASHP. Bing is regional operations performance manager for Critical Care Systems in Las Vegas and headed an ASHP task force. The task force recommended creating a "common data set" of patient information to encourage timely sharing of information across different care settings.

Coleman also advocates such information sharing. Involving the patient and caregivers is essential, he said. "We know that when patients assert a more active role in the discharge process, they experience better health outcomes and are less likely to return to the hospital." JCAHO is urging patients to take that more active role.

Coleman helped develop JCAHO's current "Speak Up" consumer education campaign. Among other steps, JCAHO urges patients to get details about their condition and full written instructions on medications before leaving the hospital. Both JCAHO and the Centers for Medicare & Medicaid Services have set standards on patient information, but neither group consistently enforces those standards, he said.

Some hospitals are moving on their own. In South Carolina, Anderson Area Medical Center pharmacy director Patricia White developed her own universal medication form. "It is basically a medication listing that we generate on admission," explained the center's assistant pharmacy director Jim Hammett. "We generate a copy for the patients to take with them to every physician and pharmacy they use."

The South Carolina Hospital Association (SCHA) adopted Anderson's universal medication form (UMF) and turned it into a three-part medication safety toolkit. The toolkit includes a patient brochure, a medication assessment history/physician order entry form for inpatient use, and a universal medication form for patients. The toolkit can be downloaded at http://www.scha.org/.

SCHA is also rolling out an electronic version of the UMF on a flash drive that patients can carry on a keychain or in a purse.

"We are taking this program to Joint Com-mission, to ASHP, to CMS, and the Institute for Healthcare Improvement," said SCHA VP of professional services Karen Reeves.

"There is no reason consumers can't make hospitals and community pharmacies do a better job. A universal medication form can help get everybody on the same page," she said.