How Pharmacists Can Prevent Medication Errors in Transitions of Care


By performing medication reconciliation across the care continuum, pharmacists play an essential role in preventing medication errors during transitions of care.

By performing medication reconciliation across the care continuum, pharmacists play an essential role in preventing medication errors during transitions of care.

Pharmacy professors from the Lloyd L. Gregory School of Pharmacy at Palm Beach Atlantic University recently detailed the most common causes of medication errors during care transitions and described the pharmacists’ role in mitigating them.

The researchers said the majority of medication errors stem from a lack of communication between care team members during transitions of care. Pharmacists can help correct this problem by completing medication reconciliation across the care continuum, which ensures effective patient hand off to and from post-acute care facilities.

“With education and training specializing in medication information, pharmacists are equipped with the knowledge to identify and resolve any medication discrepancies encountered during medication reconciliation,” the authors wrote, noting the intent of this “complex and at times challenging process” is to address and resolve any discrepancies in order to ensure safe and effective medication use.

To conduct medication reconciliation accurately, the Joint Commission recommends following this 5-step process:

“In the words of Eric A. Coleman, ‘Care transitions is a team sport, and yet all too often, we don't know who our teammates are or how they can help,’” the researchers wrote. “Each person involved should have clearly defined roles and responsibilities and should understand how these responsibilities may change depending upon the setting and patient.”

Still, several barriers that can impede integration of medication reconciliation across transitions of care, which include insufficient staffing, time constraints, and lack of health care provider knowledge about medications. Nevertheless, pharmacists can intervene to prevent errors and ensure patient safety.

For instance, the US Centers for Medicare and Medicaid Services “requires consultant pharmacists to conduct a medication regimen review at least monthly, (and) performing these necessary medication reconciliations allows pharmacists to play an essential role within nursing facilities,” the researchers noted. In addition, pharmacists can ensure that patients discharged from an acute care facility have a scheduled follow-up appointment in the outpatient setting, which promotes continuity of care.

“Pharmacists are integral within the team in order to evaluate the appropriateness of medication use, to ensure information is updated in the health record, and to verbally communicate accurate information to other health professionals,” the authors concluded. “…It is vital that pharmacists encourage patients, family members, and caregivers to be involved with the medication reconciliation process as active members of the health care team.”

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