Framework seeks to cut medicine errors at transitions of care

The first coordinated, hospital-based approach to medication management at transitions of care has been released by the Australian Commission on Safety and Quality in Health Care (the Commission).

The Medication Management at Transitions of Care Stewardship Framework seeks to support health services to reduce medication-related errors and hospital readmission rates for patients who are transitioning between care settings.

It has been found that 250,000 hospital admissions are due to medication-related errors each year in Australia, at a cost of about $1.4 billion. Further, more than 50% of medication errors occur at transitions of care.

Promoting identification of patients at high risk for medication-related problems is one aim of the framework and can include people who are aged over 65 years, those who take five or more medications or take a high-risk medication, and those with multiple prescribers for their medication.

Articulated in the framework is a stewardship model for these patients. This model includes comprehensive medication reconciliation, regular medication review, and early discharge planning and liaison.

“There is a real opportunity for hospital clinicians to adopt the new framework and take action to strengthen communication with the primary and aged care sectors,” said Dr Holdenson Kimura, Medical Advisor for the Commission and a general practitioner.

“We know that a lot of hospitals are very good at mitigating risk for medication error. The release of this framework creates an opportunity for health services to review and build on their approaches.

“The framework is designed to be incorporated into existing systems and clinical practice to enhance medication governance, improve communication and facilitate timely, collaborative post-discharge medication review, especially for high-risk and vulnerable patients.”

EDs are supported through the framework to identify people at high risk of medication-related problems and prioritise them for medication reviews throughout their hospital stay, Kimura said. This proactive approach reduces medication error at admission, during a hospital stay and at discharge.

“At our clinic, we always welcome a phone call to the GP or practice nurse from the treating team before a patient is discharged back into our care. This allows a conversation where significant medication changes can be identified, and I see the patient within days of their discharge to reduce risk of medication-related harm,” Kimura said.

Kimura noted that many clinicians have experienced first-hand the success of the antimicrobial stewardship model in hospitals, which supports the judicious use of antimicrobials. “It would be fantastic to see the adoption and implementation of this medication management stewardship model embedded in Australian hospitals — similar to the antimicrobial and opioid stewardship models — to improve patient care,” Kimura said.

Concerning digital tools, Kimura said: “Digital enablement will be key to realising the full potential of the framework — but these digital tools need to be interoperable to enable accurate and timely communication.

“Within the hospital setting, the digital system needs to be seamless and easily accessed by different members of the care team. This would mean that prescribing software and pharmacy dispensing software is working well together to support discharge.

“To streamline communication about medication use across settings, standardised electronic discharge summaries would be delivered automatically and securely at the time of discharge, and uploaded to the patient’s electronic health record, such as My Health Record.”

The framework, which was developed as part of the Commission’s leadership on Australia’s response to the World Health Organization Global Patient Safety Challenge: Medication without Harm, can be accessed here.

Image credit: iStock.com/Dragos Condrea