By Nareh Tahmasian
When it comes to medication error, transitioning from one healthcare setting to another is a particularly high-risk period for many patients. Whether it’s admission into a hospital, discharge from the hospital, or admission into a long-term care facility, patients are at risk of unintentional medication discrepancies that occur when there is a change in the medications they are taking that was not intended by the original prescriber. These discrepancies can result in drug therapy problems or even adverse drug events (ADE).
In Canada, up to 50 pe rcent of patients experience unintentional medication discrepancies upon hospital admission and at least 40 per cent at discharge. Many cases of medication error can be attributed to a lack of information pharmacists receive about a patient’s medication history. “Historically, hospital and community pharmacists have worked in silos,” says John Papastergiou, pharmacist and owner at Shoppers Drug Mart and assistant professor at the Leslie Dan Faculty of Pharmacy , University of Toronto. “Almost daily, community pharmacists are forced to make judgment calls on prescriptions from hospitals without a good understanding as to why the patient may be taking the medication.”
The risks of polypharmacy
“Use of multiple medications, or polypharmacy, is serious risk factor when it comes to ADEs and hospital readmissions,” says Lisa McCarthy, assistant professor at the Leslie Dan Faculty of Pharmacy and clinician scientist at Women’s College Hospital. Polypharmacy is most common among older adults, with 66 percent of Canadians over 65 take more than 5 medications on a daily basis. Older adults are also more likely to experience medication changes during hospital stays, making the risk of error particularly high among this group.
To help reduce the potential for error, Lisa McCarthy and Sara Guilcher, assistant professor at the Leslie Dan Faculty of Pharmacy, are leading a team of researchers who are testing a simple but meaningful communication link to give pharmacists across care transitions immediate access to relevant patient health information. The team is evaluating the feasibility and effectiveness of implementing the intervention, called the Pharmacy Communication Partnership, or “PROMPT,” to improve continuity of care between hospital and community pharmacists.
Currently, PROMPT is being tested during transitions from hospital to home. As part of the intervention, a hospital pharmacist directly faxes a comprehensive discharge package to the community pharmacist involved in the patient’s care. The hospital pharmacist is then accessible for follow up if needed. Fax was chosen as the first line of communication because it’s already used frequently in healthcare communications, making it the most practical and efficient tool currently available for information exchange.
“By improving communication and coordination between pharmacists in each setting, our project has the potential to improve patient safety and overall health while also reducing health-system costs,” says McCarthy, pointing out that errors can lead to costly hospital readmission.
Connecting with community
Community pharmacists are medication experts with valuable insights based on their long-standing relationship with patients, which makes them well-suited to assume leadership roles in medication management. “Our intervention gives community pharmacists time to prepare prescriptions in advance and request clarification if needed,” says Guilcher. “This way they can get in touch with the hospital pharmacist if they believe there may be a medication error or if another medication might be more suitable for the patient or covered by their health plan,” Guilcher says.
The team is working on finding ways to improve various components of the intervention as well as investigating the contextual factors that influence implementation. “Things like ‘what are the time pressures on the hospital pharmacy side?’ or ‘how many patients can we actually do this for?’” says McCarthy, referring to the factors that affect how the intervention should be delivered under different circumstances.
For example, the implementation of PROMPT in other care transitions, like from hospital to long-term care, or rehabilitation hospital to home, or implementation in rural setting where there is more interaction between different healthcare providers would all require some customization.
“These findings will identify the context and mechanisms for successful implementation and scaling-up,” says Guilcher. “Our next step is knowledge translation and exploring partnerships with other hospitals across Ontario as we move forward with scaling efforts.”
Nareh Tahmasian is a work-study student at the Leslie Dan Faculty of Pharmacy, Univerity of Toronto.