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The Pharmaceutical Journal Vol 265 No 7114 September 16, 2000
Pharmacy Practice Research
Papers presented at the British Pharmaceutical Conference, Birmingham, September 10 to 13, 2000 pR58

The transfer of patient-based information between pharmacists and other health care professionals

By A. Adeturinmo, C. Duggan* and I. Bates

Introduction Information is required by all health care professionals to provide the "integrated patient care" proposed by the Government in a White Paper.1 The importance of effective information transfer between all health care professionals is further emphasised in the NHS Executive information strategy.2 Pharmacists need to work in partnership with other professionals by sharing information with them, in order to improve the quality of service provided to patients.3
Previous research has shown that there are problems with the transfer of verbal information4 and written information5 between health care professionals. Although these studies recommend measures to improve information flow, they have not investigated how this could be implemented, and pharmacists were not included in the professionals investigated.
This study aims to examine the current method of information transfer between pharmacists and other health care professionals, to identify gaps in the transfer and subsequently design an intervention using a multidisciplinary approach to improve information transfer.

Methods The exploratory phase of the study was conducted using two qualitative methods: semi-structured interviews and non-participant observational study. The initial stage involved interviewing various health care professionals directly involved in the care of general medical patients in an east London hospital. These professionals included pharmacists, doctors, nurses, therapists and non-therapists. They were asked to describe how information is currently transferred and any problems associated with the systems in place. These health care professionals were also observed in their work practices, in order to map out information transfer from admission to discharge of general medical patients with different diagnoses.
The selection criteria for the patients recruited for the observational study was based on the admission data, so that a representative sample was observed.

Focal points

  • Information is required by all health professionals to provide the "integrated patient care" proposed by the Government in a White Paper
  • Pharmacists need to work in partnership with other professionals by sharing information with them, in order to improve the quality of service provided to patients
  • Semi-structured interviews and non-participants observational studies were carried out to investigate the current transfer of information between pharmacists and other health care professionals, and to identify gaps in the transfer
  • Pharmacists do not document their contribution to patient care, especially after patient counselling, provision of compliance aids or patient medication cards to improve patient compliance
  • Lack of documentation can hinder effective information transfer between health care professionals, which could affect patient care

Results A total of 21 health care professionals was interviewed in the initial stage of the study, comprising six pharmacists, four doctors, four nurses, four therapists and three non-therapists. Pharmacists accessed information from other health care professionals mainly through written sources, especially from drug charts and medical notes. They expressed problems with lack of drug details, incomplete documentation and illegible writing by doctors. Unlike other health care professionals, pharmacists do not attend the multidisciplinary team meetings held weekly on various wards, whereas other professionals found this a useful source of information. Pharmacists transferred information to doctors by bleeping them, leaving notes on the drug chart or occasionally documented in the medical notes. They also transferred information to nurses verbally but rarely transferred information to therapists and non-therapists.
The observational study revealed that information flows mainly from pharmacists to doctors and nurses and that a patient might be reviewed by different professionals, who transferred information through written sources such as medical notes, nursing cardex and end of bed notes. Some professionals did not document information or did not state a contact number, and others had problems tracking them down.
Although pharmacists made comments on drug charts or occasionally in the medical notes, they did not document their contribution to patient care, especially after patient counselling, provision of compliance aids or patient medication cards to improve patient compliance. Pharmacists tend to communicate verbally with nurses on the wards to sort out any drug-related issues or problems.

Discussion Health care professionals, including pharmacists, do not have a systematic method of documentation. Lack of documentation had been shown to hinder effective information transfer between health care professionals, which could affect patient care.5 The results of this study will now be presented to professional groups to design an intervention to improve information transfer.

Centre for practice and policy, School of Pharmacy, University of London, 29/39 Brunswick Square, London WC1N 1AX; *Academic department of pharmacy, Barts and The London NHS trust, St. Bartholomew's Hospital, West Smithfield, London EC1A 7BE

References

1. NHS White Paper. The new NHS: modern, dependable. Cm 3807. London: Stationery Office; 1997.
2. Burns F. Information for health. Leeds: NHS Executive; 1998.
3. The new horizon. Pharmacy in a new age. A consultation on the future of the profession. London: Royal Pharmaceutical Society of Great Britain; 1996.
4. Coiera EW, Tombs V. Communication behaviours in a hospital setting: an observational study. BMJ 1998;316:673-6.