Managing Medications during a Transition of Care

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Written by Steve Hiemenz, pharmacist and owner of Elm Plaza Pharmacy 

In a healthcare setting, transition of care (TOC) is the movement of a patient between locations or providers. TOC even includes transitioning a patient between different levels of care within the same location.

Any TOC, even when it’s with the same healthcare provider, places the patient at risk. About 1 in 5 Medicare beneficiaries will experience a hospital readmission 30 days after being discharged. In addition, after leaving the hospital, about 1 in 5 will experience an adverse event (adverse drug events account for the majority).

There are many health care professionals involved in a TOC, including physicians, nurses , pharmacists, physical therapists and social workers, just to name a few.  As a pharmacist, my main area of concern in any TOC is medications and their effect on the patient’s overall health. I evaluate the medication list before the transition, during the transition and, most importantly, at the conclusion of the transition.

It helps immensely when patients and caregivers take an active role in making the transition go as smoothly as possible. But this is easier said than done. A TOC can be overwhelming for patients and their caregivers, with so much information to process and follow-ups to plan.  You may ask yourself, “What can I do to ease the transition?” Well, you can start by following these simple guidelines for a smooth TOC:

Before the transition

A good transition of care always starts with an accurate medication list.  Your medication list should include the:

  • Medication name
  • Dosage form and strength
  • Directions and indication (why you are taking the medication)
  • Date you started taking it
  • Prescribing physician’s name and phone number

Be sure to include all prescription, over-the-counter, herbal medications and vitamins on your medication list. There are many online fillable forms you can use, or your pharmacy has a form that can help you keep track. You should also ask your doctor and pharmacist to include the indication in the directions on the prescription label. For example, “Take 1 tablet by mouth every morning for blood pressure.”  In addition, keep a record of any allergies to medications, what the reaction was and when it occurred.

During the transition

Write down your questions as they occur.  It is difficult to remember your questions during a doctor’s appointment.  Don’t accept verbal changes to your prescriptions during an appointment.   If your doctor tells you to “take 2 of your blood pressure meds instead of 1, and see me in a month” have him or her write you a prescription instead.  Even if you don’t have to fill the prescription, at least the pharmacist knows the current dosage.

After the transition

Upon discharge from the hospital, you should receive a medication reconciliation report of some type. This required report summarizes all changes to medications during the stay.  It should list the following:

  • NEW medications to start
  • Medications you are to CONTINUE
  • Medications you are to DISCONTINUE

You should also receive a written, signed prescription for ALL medications that are started OR continued.  This is very important.  A pharmacist can’t “make up” a prescription simply because it is listed as a new medication.

There are many other aspects of TOC that are important, such as physician follow-up and after-discharge care, which you can discuss with your healthcare providers. But, at least now, you have a roadmap to a smoother, more successful TOC when it comes to medications.

Elm Plaza Pharmacy, located in the medical office building at 908 Elm Street in Hinsdale, has provided pharmacy services to the residents of The Birches for over fifteen years. In addition to other services, Steven P. Hiemenz, RPh., comes to The Birches, generally on a monthly basis, to offer personal consultation on medications and related health care subjects to residents and their families.