Chapter 6: Facilitating Continuity of Medication Management on Transition Between Care Settings

INTRODUCTION Transfer of patients between health professionals, health service organisations and within health service organisations provides opportunity for medications errors if communication of the patient’s medicines information is incomplete or inaccurate. More than 50% of medication errors occur at transitions of care and up to one-third of these errors has the potential to cause harm. The Guiding Principles to Achieve Continuity in Medication Management have three guiding principles that relate to the continuity of medication management on transition between care settings: supply of medicines information to consumers, ongoing access to medicines and communicating medicines information. Pharmacists’ participation in the transition of patients between care settings supports these guiding principles. Pharmacist participation in facilitating discharge and transfer of care has been shown to reduce adverse outcomes and importantly to reduce hospital readmissions. When patients move between different settings there is a risk that their care will be fragmented. Poor communication of medical information at points of transition has been shown to be responsible for up to 50% of medication errors and up to 20% of adverse drug events. Omitting one or more medicines from the discharge summary exposes patients to 2.31 times the risk of re-admission to hospital. Communication and liaison with the patient/carer and other health professionals (e.g. GP, community pharmacists, other primary health professionals) facilitates the continuity of a patient’s medication management. Patients may have multiple prescribers including nonmedical prescribers. This communication may be via the patient’s discharge summary, medication management plan (MMP), electronic health record or equivalent. A key aspect of facilitating the continuity of medication management is to ensure the patient has affordable and continued access to the medicines they require to support their MMP. Ideally, an outreach or community liaison pharmacist would be available to facilitate patient transfer from hospital. See SHPA Standards of Practice for the Community Liaison Pharmacy Practice.