Background Research suggests that approximately 5% of hospital admissions are medicines-related. There is an increased risk from errors or unintentional changes to a patient’s medicines when their care is transferred. This includes when the patient is discharged from a hospice.

Aim(s) To identify whether patients are complying with their medicines and the types of medications related problems patients have post-discharge. To reconcile the medicines the patient is taking post-discharge against what had been prescribed on the inpatient unit.

Methods Patients deemed as medically fit by the medical team were approached by the hospice pharmacist and audit was explained to them. Those that wished to participate were contacted using their preferred method approximately two weeks post-discharge from the hospice. The data were collected using an adapted version of the medicines use review form used by community pharmacists.

Results

• A total of 20 patients were contacted

• 15% of patients had difficulties obtaining at least one of their prescribed medicines

• 5% of patients experienced at least one side effect from their medicines resulting in non-compliance

• 15% of patients chose to stop taking at least one of the prescribed medicine

• 10% of patients had medication changes made by the GP within two weeks post-discharge.

Conclusions This audit highlights some of the difficulties experienced by patients with their medication. Medicines prescribed by the team on the inpatient unit can often be quite specialised and not kept as stock in the community pharmacy causing patients to miss doses of critical medicines such as analgesics. Patients should receive counselling about their medicines before they are discharged to include information on who they should contact if they have problems with their medicines. A drug review post discharge from the hospice could also be beneficial,