Improving Medication Use at Transitions of Care

Three national quality use of medicines (QUM) publications have recently been updated. These publications are the:

• Guiding principles for medication management in residential aged care facilities 
• Guiding principles for medication management in the community; and
• Guiding principles to achieve continuity in medication management

These updated publications build upon previous versions and aim to improve the quality and safety of medication management in Australia. These guiding principles align with the National Medicines Policy with a focus on person-centred care in aged care facilities, the community and at transitions of care.

The Guiding principles to achieve continuity in medication management is particularly relevant to the hospital environment and aims to promote the quality use of medicines during transitions of care.

Transitions of care are situations where all or part of a patient’s care is transferred between healthcare locations, providers, or levels of care, including:

• Between healthcare providers (e.g. clinical handover in a hospital where one nurse hands over the responsibility for a patient’s health care to another nurse);
• Between levels of care in the same location (e.g. transfer of a patient from an emergency department to a ward in a hospital);
• Between healthcare locations or settings (e.g. transfer of care from ambulance service to an acute care service);
• When care needs change (e.g. transfer from an acute care service to an aged care home);
• When an individual’s preferences change (e.g. transfer of a patient from an oncology ward to a palliative care service due to end-of-life care preferences);
• When access to services changes (e.g. transfer of ongoing care from paediatric services to adult services); and
• Between levels of healthcare (e.g. an individual is discharged from a mental health inpatient facility back to the care of their GP).

These transitions of care form an integral part of the patient experience in the healthcare system. However, care transitions are also recognised as high-risk situations for patient safety. Studies demonstrate that more than 50% of medication errors occur at transitions of care, although this figure may be higher in some settings.

The Australian Commission on Safety and Quality in Healthcare (the Commission) highlights four transition points as being particularly prone to error. These are admission to the hospital, transfer from the emergency department (i.e. to a ward, intensive care, home), transfer from the intensive care unit to the ward, and transfer from the hospital (i.e. to home, aged care home, or another hospital).

The risk of medication errors and the potential for harm from those errors will vary depending on the patient. An individual’s risk of experiencing a medication error increases as the number of medicines they take increases. Patients at higher risk of harm from these errors include those taking high-risk medications (e.g. opioids, chemotherapy, anticoagulants) and patients with comorbidities (e.g. renal impairment).

Potential consequences of these errors include increased adverse effects, preventable readmissions, and increased morbidity and mortality. There is also likely to be significant dissatisfaction for both patients and healthcare providers alike.

Due to the significant nature of these potential outcomes, improving medication safety at transitions of care was identified as a key priority of the Medication without harm – WHO Global Patient Safety Challenge – Australia’s response. The Guiding principles to achieve continuity in medication management address this through its ten principles. Guiding principles one to four set the overarching system requirements, while the remaining principles outline specific activities.

These guiding principles, based on Commonwealth of Australia (Department of Health and Aged Care) material, are shown below.

The complete guiding principles document is available for download here; a condensed version can be accessed here.