Pros And Cons Of Transitions Of Care

Transitions in care, such as admission to and discharge from the hospital, put patients at risk for errors due to poor communication and inadvertent information loss (1–5). One discrepancy does not necessarily mean an error. In fact, most discrepancies are due to adapting chronic medication to the patient’s newly diagnosed condition, or because the examinations and/or interventions performed could interfere with their usual medication. Medication discrepancies, established as unexplained differences among documented drug regimens at the interfaces of care1 (admission, transfer, and discharge) are highly prevalent. Some are intended therapeutic modifications, but others are unintentional and clinically unjustified. Prior studies suggest that

ADEs associated with medication discrepancies can prolong hospital stays and, in the post-discharge period, may lead to emergency room visits, hospital readmissions, and utilization of other health care resources. Preventable adverse drug events (PADE) are associated with 1 of 5 injuries or deaths and a result of poorly designed systems, which often lack independent redundancies. Preventable ADEs at transition points of care account for 46-56% of all medication errors. One strategy to reduce PADEs and ADEs is to reconcile the medication orders between the two transition points. The Institute for Healthcare Improvement (IHI) defines medication reconciliation as a formal process to compile a list of all the medications a patient is taking before admission, and comparing it with the doctor’s admission, transfer and discharge orders. In 2007, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) acknowledged that reconciliation errors compromise the safety of drug use and recommended hospitals to develop a system for obtaining patients’ complete pharmacotherapeutic records, to ensure they receive the necessary drugs for the new