The Care Transition: A Crucial Time for Patient Safety

Over 1,400 patients are treated daily across Huntsville Hospital Health System, the second largest in Alabama. When a patient is admitted or discharged at any of the Huntsville/Madison County locations—a crucial time for patient safety—the Pharmacy Transitions of Care (TOC) team jumps into action.

What is medication reconciliation?

Answering this question and providing this service is a key to patient-centered care because, if done well, medication reconciliation can greatly reduce medication errors at the point of admission or discharge. Such errors may include the wrong dose, incorrect timing, or even the wrong medication altogether, which can lead to adverse drug events and subsequent readmissions.

“People don’t know what medicine they take,” notes Dr. Daniel Fox, a hospitalist at Huntsville Hospital. “Sometimes they can’t remember what pharmacy they use. If they have a printed list, you better make sure it’s not from three years earlier.”

Medication reconciliation begins with creating the most complete and accurate list of a patient’s medications. According to The Joint Commission, it is the “process of comparing the medications a patient is taking (or should be taking) with newly ordered medications,” and resolving any discrepancies.

Forming a Pharmacy “Transitions of Care” Team

Medication discrepancies are nothing new.

Research published in the American Journal of Health-System Pharmacy suggests that two of five patients admitted to hospitals have medication discrepancies, and these discrepancies persist at the time of discharge. The study concludes that pharmacists can identify and correct discrepancies, thereby avoiding adverse drug events.

So, Huntsville Hospital formed a team of 15 pharmacists and 30 pharmacy technicians to make this happen.

The goal of reducing medication errors at transitions of care starts with improving the accuracy of the medication history itself, and for that, the Transitions of Care team relies greatly on Surescripts Medication History for Reconciliation.

This solution aggregates dispensed medication history data—accurate medication history data—and delivers it from pharmacy benefit managers (PBMs) and pharmacies directly into the electronic health record (EHR) at the hospital.

“I can’t oversell how much people love it,” says Joseph Ho, who leads clinical pharmacist education at Huntsville Hospital. “Our techs rely on it. Their eyes light up.”

Their eyes light up because they don’t have to enter medical records into the system by hand or rely as much on patient recall and handwritten lists. They don’t need to call pharmacies and prescribers to confirm medications or wait for a facility or health plan to fax a list of the patient’s medication history.

98.9% Reduction in Medication History Misinformation and Errors

“Because of the work of the Transitions of Care team and use of Surescripts,” Ho says, “our doctors and nurses feel much more secure about the medication list when performing admission reconciliation, and when discharging patients.”

No more printouts. No more color markers. No more triple-checking. All this saves time, not to mention the reduction in adverse drug events and associated readmissions across acute, post-acute and long-term care settings.

“If a pharmacist doesn’t have to call me to confirm or verify information that I have documented,” says Kayla Johnson, Pharmacy Transitions of Care technician at Huntsville Hospital, “that’s success for me.”