JMIR Publications

ABSTRACT

Background:

Transitions of care, where patients move between clinical settings or providers, pose considerable risks to patient safety. This challenging period is further compounded by the absence of adequate digital infrastructure that enables information exchange. Timeliness and accuracy of medication information transfer are central to ensuring patient safety during transitions of care, including post-discharge from hospital. In designing a multi-faceted digital intervention to support transfer of medication information from hospital to community settings, it was necessary to gauge the views of all relevant stakeholders on the practical challenges involved in transferring medication information.

Objective:

To define the challenges experienced by stakeholders, develop potential solutions, and use a collaborative approach to design a multi-faceted digital intervention that spans healthcare settings.

Methods:

This project involved multiple health service organisations in Queensland (QLD), Australia’s second largest state geographically. Design of the intervention was guided by the United Kingdom Design Council’s Double Diamond Framework. Over 12 months, we held an initial workshop with consumers (n=4), hospital (n=6) and primary care clinicians (n=7), and then convened over 50 hours of committee meetings, working groups, and consultations, undertook a system-walkthrough, and performed feasibility testing of the intervention. Participants were patients with relevant lived experiences, clinicians, and those with technical, clinical governance, policy, research, and digital health implementation expertise.

Results:

Challenges described by workshop participants included fragmented digital systems across care settings, delays in discharge documentation reaching primary care clinicians, and current systems functioning as incomplete or inconsistently used sources of medication information. Stakeholder consultation led to our multi-faceted intervention comprising both clinician- and patient-facing elements. These include: a hospital-based Pharmacist Navigator role to facilitate handover post-discharge; a clinical dashboard for identifying and stratifying patient risk of medication misadventure; a software application for post-discharge pharmacist-led medication review and communication of the review to the patient’s general practitioner (GP), Pharmacist Navigator notifying GPs of a patient’s hospital stay; patient education materials; and online training of community pharmacists to conduct medication reviews.

Conclusions:

Designing a multifaceted digital intervention to support medication information transfer at hospital discharge required significant time, effort, coordination and engagement from a large number of stakeholders with various roles and expertise. Key learnings are that transitional care interventions must be agile and modifiable to align with the complex adaptive nature of healthcare, and that a digital intervention relies heavily on human elements and support to be successful.