Lost in transition


pharmacist with patient explaining medicines

Rate of errors are still too high at care transition, and HMR funding caps are not helping: experts

Problems with coordination of care are still leading to an unacceptable level of medication errors, says a team of experts who has highlighted some areas that could improve the situation.

A review article by a multidisciplinary research team has highlighted the scope of the problem and suggested a range of potential solutions, including emphasising the value of medication reviews.

People with complex medication regimens, older people, those with mental health problems, people who are poor or have low literacy, and Aboriginal and Torres Strait Islander and migrant populations are particularly at risk of medication discrepancies, the authors said.

One example they highlighted was recent research on clozapine, which showed that discrepancies with concomitant medications can have potentially fatal outcomes.

This research revealed very high rates of medication discrepancies across shared-care medication records in a Queensland service, which the review authors said were “of significant concern”.

Overall, 32 of 35 patients had at least one medication discrepancy, mostly omissions, with an average of 4.9 per consumer. Specialist records had the highest number of discrepancies (74%), followed by GP records (70%) and community pharmacy (62.5%).

The key to reducing these potentially serious medication errors and patient harm is to ensure timely, accurate handover of medicines at all transition points in care, and to involve the patient and their carers, said authors Professor Amanda Wheeler from Griffith University and colleagues.

Among the key steps they identified are medicines reconciliation, discharge planning, electronic prescriptions, e-health records and medicine reviews.

“Providing a PBS prescription on discharge for one month’s supply should be reconciled by a pharmacist against the Discharge Medication Record, to ensure that patients have access to any new or changed medicines and an adequate supply of continuing medicines,” said the authors.

“The hospital pharmacist can liaise with the patient’s community pharmacist to organise dispensing in the community, particularly if a dose administration aid is needed. It also allows the pharmacist to provide the consumer with information to manage their medicines (eg. with their own copy of the Discharge Medication Record).

“However, effective discharge planning requires cooperation between doctors, pharmacists and nurses in the hospital and community,” they said.

Medication reviews undertaken shortly after hospital discharge have also been shown to reduce adverse events and provide an opportunity for medicines reconciliation, they added.

However, the current funding cap came under criticism for restricting the programs efficacy.

“Research has shown that Home Medicines Reviews reduce hospital admissions for people on high-risk medicines, the current funding cap and referral pathways restrict access to the program.

“A patient-centred approach is key to improvement, along with strategies including integrated care pathways facilitated by technology and shared accountability,” the reviewers concluded.

“All healthcare providers need to commit to the consumer being central to the goal of medications accuracy”.

The article was published recently in Australian Prescriber 

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1 Comment

  1. (Mary) Kay Dunkley
    05/06/2018

    Good to have this research but this is something we have known for many years now and we still do not have the mechanisms in place to address the problem. I recall work being done in this area 25 years ago well before we had any of the possible technological solutions we now have. Will My Health Record provide a solution – only if we have pharmacists undertaking reconciliation at each transition point to ensure the data is accurate.

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