Pharmacy hand off communication is defined as a formal process for communicating medication changes made in the inpatient setting to pharmacists in the outpatient setting.
Communication Template - Developed by PSW PPMI Leadership Team in 2015 for use from hospital to next pharmacy provider of care. Perfect for customization and incorporation into hospital EHR.
Corresponding PPMI Recommendations
- B20: Pharmacists should facilitate medication-related continuity of care
- B21: Pharmacists should use patient specific data to be leaders in disease prevention and wellness
- B23L: Establishment of processes to ensure medication-related continuity of care for discharged patients
Wisconsin Transitions of Care Survey Results
- 45% of sites have an interest in implementing pharmacy communication from the inpatient to the outpatient setting
- 24% of sites state that they have some form of communication between the inpatient and outpatient pharmacy settings
- 7.3% have established relationships with non-affiliated outpatient pharmacies to help with care transitions
- 8.2% indicate that medication related discharge information is provided to community pharmacies at discharge
- 14.6% of sites verify completion of medication reconciliation with pre-admission medications when filling discharge prescriptions
Care transitions have been noted to be associated with increased risk from medical errors due to suboptimal coordination.1 These medication errors can arise from dated medication lists and imperfect communication of information from one institution to another. One prospective cohort study found that one in five patients discharged from the hospital to home experienced an adverse event within three weeks of discharge, and that 66% of these were drug-related and could have been prevented.2 A lack of communication between hospital and ambulatory physicians has been clearly demonstrated to adversely affect post-discharge care transitions, decreasing the quality of care in approximately 25% of follow-up visits.3 Studies examining hand off from inpatient pharmacists to outpatient pharmacists are limited; however our survey results suggest that it is not a common practice for hospital pharmacist to engage in structured hand off to their counterparts in the community. Increasing communication between the inpatient and outpatient pharmacy settings may represent an opportunity to decrease adverse events, provide smoother transitions, and facilitate better engagement of patients in their medication regimen post-discharge. The following organizations have issued statements advocating for hand off communication among pharmaceutical care providers at discharge:
ACCP Improving Care Transitions: Current Practice and Future Opportunities for Pharmacists
“A hospital pharmacist should […] provide medication counseling, including written medication information; verify patient comprehension with medication instructions; address potential adherence concerns; and communicate a reconciled medication list to the patient’s follow-up provider and community pharmacist”4
ASHP-APhA Medication Management in Care Transitions Best Practices
“Collaboration and effective communication between members of the multidisciplinary health care team both within an institution and between health care providers in various settings is critical to effective care transitions.”5
National Quality Forum - Preferred Practices and Performance Measures for Measuring and Reporting Care Coordination: A Consensus Report
“Preferred Practice 22: Healthcare organizations should develop and implement a standardized communication template for the transitions of care process, including a minimal set of core data elements that are accessible to the patient during care. […] All parties caring for the patient should be aware of important clinical information that may impact care.”6
“Preferred Practice 23: Healthcare providers and healthcare organizations should implement protocols/policies for a standardized approach to all transitions of care. Policies and procedures related to transitions and the critical aspects should be included in the standardized approach.”6
Current State and Future Directions
Hand off communication among pharmacists during patient discharge was identified by the PSW PPMI Leadership Team as an area with significant opportunities for improvement. An initial literature search for published studies evaluating pharmacy driven discharge hand off processes did not yield any results. Inquires of institutions across Wisconsin revealed what was relatively expected: hand off communication between pharmacy professions in the inpatient and outpatient setting is a rare occurrence and, when completed, it is typically done in an unstandardized and selective fashion. This is inconsistent with guideline recommendations for hand off communications between health care professions and may be a significant contributing factor to suboptimal medication therapy outcomes associated with poorly coordinated care transitions. Best practices for hand off recommend a standardized approach for all transitions of care.
Further study is needed to fully characterize the barriers to sharing information across different pharmacy settings. Likely contributors include concerns about privacy and protected health information, information systems which are not configured to facilitate information sharing, lack of perceived need or usefulness, and a lack of time to engage in hand off leading to prioritization of other patient care tasks above it. Identifying and addressing perceived and actual barriers to information sharing will be imperative for implementing a standard of practice around the sharing of pertinent information regarding medication therapy with the next pharmacist managing drug therapy.
There are a number of benefits that may be realized by engaging in hand off activities at discharge. The availability of knowledge is a known barrier for the provision of additional clinical services in the community setting. A 2009 survey published in the Journal of the American Pharmacist Association of 970 outpatient pharmacists found that one of the most commonly sighted barriers for not providing medication therapy management services to their patients is a lack of access to health information.7 The regular provision of discharge hand off information could allow for better engagement of patients in their drug therapy post-discharge by outpatient pharmacists. Studies have shown that consultative services delivered by clinical pharmacists result in significantly decreased inpatient visits versus patients who do not receive this service.8
The PSW PPMI Leadership Team believes that pharmacy has a professional obligation to begin to examine this gap and take ownership of hand off communications among pharmacy professionals. We are currently identifying opportunities to collaborate with pharmacists across multiple care settings to find innovative ways to meet this challenge. Additionally, the results of our analysis have been passed on to individuals who will be attending the ASHP Ambulatory Care Summit to be considered during deliberations on the future roles of pharmacy in ambulatory care. The next phase of our leadership team’s work will be to identify the most optimal means of supporting the continued expansion of vital services delivered by pharmacy to improve care transitions.