There Has To Be A Better Way Of Doing This - Hospital Pharmacists’ Perspectives On Optimising Medication Management During Hospital To Home Transitions Of Care

• By: GILMARTIN-THOMAS, Julia (Victoria University, Australia)
• Co-author(s): Dr Julia Gilmartin-thomas (Institute for Health and Sport, Victoria University, Melbourne, Australia)
  Ashlea Shaune (Pharmacy Department, Western Health, Melbourne, Australia)
  Dr Sam Keast (Institute for Health and Sport, Victoria University, Melbourne, Australia)
  
• Abstract:

  Background information
  
  The World Health Organization ‘Medication Safety in Transitions of Care’ 2019 report noted that “the most important challenge in the field of patient safety is how to prevent harm, particularly avoidable harm, to patients during their care”. Medication-related harm associated with transitions of care is a major public health problem in Australia. The Pharmaceutical Society of Australia’s 2019 ‘Medicine Safety: Take Care’ report highlighted that over 90% of patients have at least one medication-related problem post-hospital discharge, and 250,000 hospital admissions annually are due to medication-related problems.
  
  Purpose
  This study undertook an in-depth exploration of factors contributing to medication-related problems arising from hospital to home transitions of care and opportunities for hospital pharmacist involvement.
  
  Method
  A case study approach was used to comprehensively examine a specific Australian tertiary care hospital environment that services a large metropolitan population at high risk of medication-related problems, chronic co-morbidities and low health literacy. A single focus group was used, directed by a semi-structured question guide and held via an online communication platform. A combination of convenience and purposive sampling was used to select participants. A thematic approach was used to develop meaningful themes arising from qualitative data in a systematic manner. The study was approved by the University Human Research Ethics Committee (HRE21-174).
  
  Results
  Six hospital pharmacists who worked at a large, tertiary care, metropolitan hospital and healthcare organisation participated in the focus group. Ineffective medication-related communication with the patient, among the hospital healthcare team, and between the hospital and community healthcare team were identified as the main contributing factors to medication-related problems arising from hospital to home transitions of care.
  
  Participants identified that the patient may not receive comprehensive medication-related counselling in the hospital setting, prior to discharge, and information may be incorrectly communicated to the carer, under the assumption that the patient doesn’t manage their own medications (especially if the patient was living with dementia). Participants highlighted that cultural considerations (not speaking English as a primary language), (poor) health literacy, patient preferences (lack of translators available for all patient languages), and timing of counselling (during the busy discharge process) could impact how effectively medication-related information was received by the patient during hospital to home transitions of care.
  
  Participants suggested that more regular and systematic incorporation of hospital pharmacists in discharge planning and medication management decision making (facilitated by attending ward rounds with the entire medical team) and pharmacists planning and preparing for discharge medication counselling well in advance of the discharge date (facilitated by prioritising workloads) could work towards addressing identified challenges.
  
  
  Conclusion
  One of the main factors contributing to medication-related problems arising from hospital to home transitions of care is ineffective communication between healthcare providers and the patient. While calls for hospital pharmacy leadership in transitional care are not new, this exploratory study indicates that there are still avenues where space should be made for hospital pharmacists to be involved in the transition of care processes – including in medication-related decision making and planning.