Main Article Content
Medication Reconciliation, Medical History Taking, Medication Errors, Patient Admission, Pharmacists, Professional Practice, United States
Objective: To introduce pharmacists to the process, challenges, and opportunities of creating transitions of care (TOC) models in the inpatient, ambulatory, and community practice settings.
Methods: TOC literature and resources were obtained through searching PubMed, Ovid, and GoogleScholar. The pharmacist clinicians, who are the authors in this manuscript are reporting their experiences in the development, implementation of, and practice within the TOC models.
Results: Pharmacists are an essential part of the multidisciplinary team and play a key role in providing care to patients as they move between health care settings or from a health care setting to home. Pharmacists can participate in many aspects of the inpatient, ambulatory care, and community pharmacy practice settings to implement and ensure optimal TOC processes. This article describes establishing the pharmacist’s TOC role and practicing within multiple health care settings. In these models, pharmacists focus on medication reconciliation, discharge counseling, and optimization of medications. Additionally, a checklist has been created to assist other pharmacists in developing the pharmacist’s TOC roles in a practice environment or incorporating more TOC elements in their practice setting.
Conclusion: Optimizing the TOC process, reducing medication errors, and preventing adverse events are important focus areas in the current health care system, as emphasized by The Joint Commission and other health care organizations. Pharmacists have the unique opportunity and skillset to develop and participate in TOC processes that will enhance medication safety and improve patient care.
2. The Joint Commission. National Patient Safety Goals Effective January 1, 2014. Hospital Accreditation Program. Available from: http://www.jointcommission.org/assets/1/6/HAP_NPSG_Chapter_2014.pdf (Accessed March 13, 2014).
3. Society of Hospital Medicine. Better outcomes by optimizing safe transitions (BOOST) Project. Available from: http://www.hospitalmedicine.org/ResourceRoomRedesign/RR_CareTransitions/html_CC/06Boost/02_TARGET.cfm (Accessed August 26, 2013).
4. Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in communication and information transfer between hospital-based and primary care physicians: implications for patient safety and continuity of care. JAMA. 2007;297(8):831-841.
5. Moore C, Wisnivesky J, Williams S, McGinn T. Medical errors related to discontinuity of care from an inpatient to an outpatient setting. J Gen Intern Med. 2003;18(8):646-651.
6. American College of Clinical Pharmacy, Hume AL, Kirwin J, Bieber HL, Couchenour RL, Hall Dl, Kennedy AK, LaPointe NM, Burkhardt CD, Schilli K, Seaton T, Trujillo J, Wiggins B. Improving care transitions: current practice and future opportunities for pharmacists. Pharmacotherapy. 2012;32(11):e326-e337. doi: 10.1002/phar.1215
7. Schnipper JL, Kirwin JL, Cotugno MC, Wahlstrom SA, Brown BA, Tarvin E, Kachalia A, Horng M, Roy CL, McKean SC, Bates DW. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med. 2006;166(5):565-571.
8. Koehler BE, Richter KM, Youngblood L, Cohen BA, Prengler ID, Cheng D, Masica AL. Reduction of 30-day postdischarge hospital readmission or emergency department (ED) visit rates in high-risk elderly medical patients through delivery of a targeted care bundle. J Hosp Med. 2009;4(4):211-218. doi: 10.1002/jhm.427
9. Jack BW, Chetty VK, Anthony D, Greenwald JL, Sanchez GM, Johnson AE, Forsythe SR, O’Donnell JK, Paasche-Orlow MK, Manasseh C, Martin S, Culpepper L. A reengineered hospital discharge program to decrease rehospitalization: a randomized trial. Ann Intern Med. 2009;150(3):178-187.
10. U.S. Department of Veteran Affairs. Veteran Health Administration- About VHA. Available from: http://www.va.gov/health/aboutVHA.asp (Accessed July 24, 2013).
11. U.S Department of Veteran Affairs. Philadelphia VA Medical Center. Available from: http://www.philadelphia.va.gov/index.asp (Accessed August 15, 2013).
12. Bindman AB, Blum JD, Kronick R. Medicare's transitional care payment--a step toward the medical home. N Engl J Med. 2013;368(8):692-694. doi: 10.1056/NEJMp1214122
13. American College of Clinical Pharmacy, Kirwin J, Canales AE, Bentley ML, Bungay K, Chan T, Dobson E, Holder RM, Johnson D, Lilliston A, Mohammad RA, Spinler SA. Process indicators of quality clinical pharmacy services during transitions of care. Pharmacotherapy. 2012;32(11):e338-e347. doi: 10.1002/phar.1214