Unit 3 lec

• Transitions of care involve movements of patients between home, hospital, residential care settings, and consultations with different healthcare providers
• Reducing medication-related harm at transitions requires long-term leadership commitment, coordination, collaboration, formulation of goals and strategies, and investment of resources
• Patient journey across different transitions of care and medication use process is essential for medication safety
• Medication use process includes transcribing, prescribing, monitoring, dispensing, and administering
• Changes in medication during transitions of care between home and hospital involve admission, obtaining medication history, verifying medication history, changes during hospital stay, reconciliation at admission and discharge, pre-discharge communication, and patient engagement
• Reasons for medication changes during transitions of care include transitions within or across healthcare settings, starting, changing, or discontinuing non-prescription or over-the-counter medication, herbal, traditional or complementary medicines, medications obtained from friends or family members, medications from unsafe sources, and substances with abuse potential
• Medication reconciliation involves building the best possible medication history, reconciling it with prescribed medication, and communicating accurate medication information
• Medication discrepancy can be intentional or unintentional, leading to medication errors and harm
• Medication review aims to optimize medicine use and improve health outcomes by detecting drug-related problems and recommending interventions
• Medication-related harm includes preventable adverse drug events due to medication errors or misuse, and non-preventable adverse drug events like adverse drug reactions
• Medication-related harm can be categorized into preventable adverse drug events (e.g., due to medication error or misuse) and non-preventable adverse drug events (e.g., adverse drug reactions)
• Frequency of Medication-Related Harm at Transitions of Care:

  • Community: 14-98% of community-dwelling older persons and 27-57% of those in residential aged care facilities had medication discrepancies
  • Hospital Admission: 3-97% of adult patients and 22-72% of pediatric patients had at least one medication discrepancy at admission
  • Discharge: 25-80% of patients had at least one medication discrepancy at discharge
  • Transfer within Hospital: 62% of patients had at least one unintentional medication discrepancy at transfer between units in the hospital
• Omission Post-Discharge:

  • Example: A man was changed from warfarin to rivaroxaban in the hospital, but the anticoagulant was mistakenly omitted in the discharge prescription, leading to a stroke and death
  • Factors: Omission, transcribing error
• Non-Adherence: Harm Due to Commission:

  • Example: A patient developed extreme opioid toxicity after not taking methadone before admission due to selling it, leading to the need for reversal with Naloxone
  • Scenario: Patient's non-adherence to prescribed medication
• Lack of Integrated Care for Physical and Mental Health:

  • Example: A 75-year-old resident experienced lithium toxicity due to deteriorating renal function, resulting in a severe manic episode due to discontinuation and lack of communication among healthcare professionals
  • Importance: Mental and physical health considerations are crucial
• Discharge Prescribing Error and Delay in Identifying Medication-Related Harm:

  • Example: A prescribing error led to a patient receiving olanzapine instead of lansoprazole, causing illness and readmission until the error was identified during medication reconciliation
  • Lesson: Always double-check and validate information
• Swiss Cheese Model (Hypothesis of Error Prevention Proposed by James Reason):

  • Model explaining how errors can occur due to multiple system failures aligning like holes in slices of Swiss cheese
• Improvements on Medication Safety in Transitions of Care:

  • Engagement with Patients, Families, and Caregivers
  • Medication Reconciliation
  • Health Workforce and Skills Mix Considerations for Medication Reconciliation
  • Improvement in Information Quality and Availability Across Transitions