RESUMO
OBJECTIVES: To evaluate a strategy designed to optimise care and increase uptake of urate-lowering therapy (ULT) during hospitalisations for gout flares. METHODS: We conducted a prospective cohort study to evaluate a strategy that combined optimal in-hospital gout management with a nurse-led, follow-up appointment, followed by handover to primary care. Outcomes, including ULT initiation, urate target attainment, and re-hospitalisation rates, were compared between patients hospitalised for flares in the 12 months post-implementation and a retrospective cohort of hospitalised patients from 12 months pre-implementation. RESULTS: 119 and 108 patients, respectively, were hospitalised for gout flares in the 12 months pre- and post-implementation. For patients with 6-month follow-up data available (n = 94 and n = 97, respectively), the proportion newly initiated on ULT increased from 49.2% pre-implementation to 92.3% post-implementation (age/sex-adjusted odds ratio (aOR) 11.5; 95% confidence interval (CI) 4.36-30.5; p < 0.001). After implementation, more patients achieved a serum urate ≤360 micromol/L within 6 months of discharge (10.6% pre-implementation vs. 26.8% post-implementation; aOR 3.04; 95% CI 1.36-6.78; p = 0.007). The proportion of patients re-hospitalised for flares was 14.9% pre-implementation vs. 9.3% post-implementation (aOR 0.53, 95% CI 0.22 to 1.32; p = 0.18). CONCLUSION: Over 90% of patients were initiated on ULT after implementing a strategy to optimise hospital gout care. Despite increased initiation of ULT during flares, recurrent hospitalisations were not more frequent following implementation. Significant relative improvements in urate target attainment were observed post-implementation; however, for the majority of hospitalised gout patients to achieve urate targets, closer primary-secondary care integration is still needed.
RESUMO
BACKGROUND: The safe supply of medicines is an integral part of being discharged from hospital. Locally, nurses are responsible for assembling medication for discharge prescriptions. Over a 2-year period 15 serious medication errors relating to discharge were reported on the health and ageing unit. This project was designed to evaluate whether a discharge medication checklist could reduce errors on nurse-assembled discharge prescriptions. METHODS AND RESULTS: A baseline audit was conducted to identify the number of medication errors on nurse-assembled discharge prescriptions. After the audit period the discharge medication checklist was introduced and education and training was provided to nursing staff. There was a statistically significant reduction in the number of assembled discharge prescriptions with one or more errors (28/56 vs. 9/44; p=0.0478) when re-audited. CONCLUSION: The introduction of a discharge medication checklist demonstrated a significant reduction in errors. The authors recommend that the discharge medication checklist and training programme be rolled out across medical wards to facilitate safe discharge.
