The Impact of Pharmacist Transitions of Care Interventions in Identifying Medications Errors for Patients Discharging to a Skilled Nursing Facility.

Background: Patients being discharged from acute care facilities have a high risk of hospital readmission due to medication errors. Pharmacist interventions during transitions of care (TOC) may be beneficial in identifying medication errors and improving patient outcomes when discharging to a skilled nursing facility (SNF). Objective The objective of this study was to evaluate the impact of pharmacist interventions in reducing medication errors for patients being discharged from an acute care facility to a SNF. Setting A community hospital that is part of a larger health network in Southern California. Practice Description Clinical pharmacists provide TOC interventions to high-risk patients discharging home. Practice Innovation Over a three-month period, pharmacists provided TOC interventions to patients discharging from a hospital to a SNF. A retrospective chart review evaluated documented pharmacist interventions to identify and categorize medication errors based on the potential for harm. Results Pharmacists saw 324 patients being discharged from the hospital and identified a total of 33 medication errors. A total of 61% of errors were related to incorrect dose, frequency, or route of administration, while 51.5% had a capacity to cause temporary harm. Only 1 error could have necessitated intervention to sustain life. Ultimately, 76% of pharmacist interventions were accepted by the patients' physicians or health care teams. Discussion Pharmacists' interventions, in addition to communication with the health care team, were able to prevent medication errors with potential to cause harm as patients transitioned from a hospital to a SNF. Conclusion Pharmacists can support safe transitions for patients discharging from the hospital to the SNF.