Co-design of a multifaceted intervention to improve quality handover of medicine information at discharge from hospital

Abstract

Background: Timely and accurate discharge medicine information is essential for primary care clinicians, including general practitioners and community pharmacists, to provide safe and effective post-discharge care. Inadequate handover of discharge medicines poses risks of medication-related harm, compromising patient safety and leads to hospital readmissions. This study aimed to develop a multifaceted intervention targeting older patients (>65 years) to enhance medicine handover at hospital discharge.

Methods: Following an initial consensus-building workshop, a structured five-step co-design process was implemented. Step 1 involved workshops and interviews with hospital clinicians, hospital leadership, primary care providers, and consumers experienced in discharge medicine handover. Stakeholder input in Step 2 refined intervention components and developed training materials. Step 3 obtained endorsement from health service decision makers and governance approvals. Step 4 included pharmacist upskilling, end-user testing, and feedback collection. Step 5 finalised intervention components and constructed a Logic Model.

Results: Seventy-eight stakeholders participated in workshops and interviews from August to November 2023. Four key medicine handover objectives for older patients emerged, which were operationalised into intervention recommendations over a five-month period (December 2023-April 2024). Component 1 empowered patients to query clinicians about their medications via a dedicated website with a question builder and evidence-based resources. Component 2 involved training doctors to document reasons for medicine changes in patient records. Component 3 implemented patient risk stratification to guide tailored strategies for communication to primary care clinicians. Component 4 focused on discharge reconciliation planning by unit pharmacists in collaboration with physicians. End-user testing yielded positive feedback.

Conclusions: A co-designed multifaceted intervention was developed to enhance medicine handover during hospital discharge. The intervention will undergo feasibility testing to assess its impact on reducing medication-related harm and hospital readmissions.

Keywords: Co-design; Discharge medicine handover; Hospital pharmacist; Information transfer; Medication management.