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$3.5 billion is spent on excess medical costs of adverse drug events annually with medication discrepancies being present upon admission or discharge in up to 70% of patients.^(1-2) This is very alarming and stands out as a major opportunity for pharmacists to make a positive impact on healthcare. There is a higher risk of adverse events and increased hospital readmission rates due to medication discrepancies resulting from transitions of care.⁽³⁾ The reason I am bringing light to this subject is it’s best suited for pharmacists to become involved. Pharmacists are experts in preventing errors and managing medications which is why I feel that it is important to include a pharmacist in transitions of care. 

What exactly Transitions of Care (TOC)? ASHP defines TOC The movement of a patient from one setting of care to another. In concert with physicians, nurses, and others who contribute to the overall medical care of patients, pharmacists optimize medication therapy that translates into improved outcomes, reduced readmissions, and the overall goal of improved quality of life for patients.

There are current Transitions of Care Pharmacists at a variety of practices and their duties entail performing and/or overseeing transitional care interventions for high-risk patients. This can include but is not limited to admissions, discharges, medication reconciliation, concierge services, patient risk stratification, and providing patient education. TOC pharmacists are working with interdisciplinary teams that identify and address risk factors that will reduce 30-day hospital readmissions.

As a profession, pharmacists are trained to facilitate communication pertaining to medications. This includes communication between providers as well as with patients: reconciliation, histories, counseling during hospitalization, and follow up with both the PCPs as well as the patients. Healthcare is complex and its integrity is dependent on every detail no matter how big or how small. The flow of information between providers and to patients is critical to desired health outcomes which is why effective transitions of care are so essential. Studies have shown that pharmacists and pharmacy students are and accurate when collecting admission medication histories compared to other providers.⁽⁴⁾ It is clear that pharmacists have the potential to improve transitions of care through their medication reconciliation skills.

 It’s time to add a Transitions of Care Pharmacist to your team.

References:

1. Institute of Medicine. Committee on Identifying and Preventing Medication Errors. Preventing Medication Errors, Washington, DC: The National Academies Press 2006.
2. Mueller SK, Cunningham Sponsler K, Kripalani S, et al. Hospital-based medication reconciliation practices: a systematic review. Arch Intern Med. 2012; 172:1057–69.
3. Coleman EA, Smith JD, Raha D, Min S. Posthospital medication discrepancies. Arch Intern Med. 2005; 165:1842-7.
4. Lubowski TJ, Cronin LM, Pavelka RW, et al. Effectiveness of a medication reconciliation project conducted by PharmD students. Am J Pharm Educ. 2007; 71:article 94.