February 20, 2025 • 12 mins
In this episode, we’ll focus on Transitions of Care (TOC) and the critical role pharmacists play in ensuring medication safety and continuity during care transitions. We’ll explore ISMP Best Practice 21 recommendations, discuss how pharmacist-led interventions help reduce hospital readmissions, and review key CMS and Joint Commission quality measures that reinforce the pharmacist’s role in TOC programs.
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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:03):
Welcome to the First Fill.
My name is Yara Al Shaer and I serveas the executive fellow and education at APhA.
I'm very excited to be your host todayto discuss one of my favorite topics.
Today, we're focusing on a crucial aspectof pharmacy practice transitions of care,
where pharmacies play an essential rolein ensuring medication safety, preventing errors
and improving patient outcomes from conductingmedication, reconciliation, hospital admissions
(00:28):
and discharge to collaboratingwith health care teams and educating patients.
Pharmacists help prevent medicationrelated errors and reduce hospital readmissions.
Transition of care is more than just a process.
It's a patient safety priority that impactsoverall health care, quality and system
performance.
Before we dive in, I'd like to introduce my gueststoday, Katie and Hailey.
(00:51):
Katie and Hailey,why don't you introduce yourselves?
Thank you, Yara.
Hi, everyone. This is Katie Meyer.
I serve as the Senior Director of Content Creationat APhA, and I'm excited
to talk about this topic today with you.
Thanks for having me, Yara and Katie.
My name's Hailey.
I am the Senior manager of CustomEducation here at APhA.
(01:11):
Looking forward to this.
Well, welcome.
Excited to have you both here today.
A key focus of of our conversationtoday will be the ISMP Best Practice 21,
which outlines strategies for preventingmedication errors during transitions of care.
We will also explore how pharmaciescontribute to hospital performance metrics
by aligning with the Joint Commission and Centersfor Medicare and Medicaid Services.
(01:36):
These CMS quality measures, including medicationreconciliation and post-discharge interventions.
In part 2, I’ll welcome an expert in the field,Larissa Bethishou and we'll focus on strategies
for preventing medication errorsduring transitions of care, with an emphasis
on medication reconciliation and effectivecollaboration across health care teams.
(01:56):
So let's dive into today's discussionon how pharmacists can optimize
transition of care interventionsto enhance patient care and safety.
Katie, can you level set with our listenersabout what transitions of care entail,
the importance of involving pharmaciesand the prevalence of medication errors during
these transitions?
Of course, yeah.
(02:16):
So from a definition perspective,the term transitions of care refers
to the movement of a patientfrom one health care setting to another.
This could includenot only changes in levels of care, for example,
from the hospital to post acute rehab,but also changes in providers or services.
Evidence has demonstrated that poor communicationamong health care
(02:39):
providers, a lack of standardized processesand shifts in patient
acuity can leave patients vulnerable to medicationerrors during these care transitions.
While being discharged from the hospital is oftenseen as a positive step,
the process can be fraught with medicationrelated changes.
Patients may struggle with new prescriptions,unclear instructions
(03:02):
or unexpected costs that make their medicationsunaffordable every year.
Medication errors contribute to over 7000 deaths.
One study found that 30%
of patients experienced at least one medicationerror during transitions of care.
The good news
is that we as pharmacists,are well equipped to play a vital role in ensuring
smoother transitions, preventing those medicationerrors and improving patient outcomes.
(03:26):
Research has shownthat pharmacist led interventions during
transitions of care can reduce hospitalreadmissions, minimize medication
errors, enhance overall health care outcomesand improve patient satisfaction.
They also help decrease the inappropriateutilization of health care services,
reducing costs while improving outcomes.
(03:50):
Thank you, Katie.
Hailey, can you share with our audiencesome pharmacist led interventions
during transitions of care that have been shown
to improve patient outcomes and reduce readmissionrates?
Absolutely.
So pharmacists can play a crucial rolein transition of care.
Their interventions, such as medicationreconciliation, patient education,
identifying and addressing barriersand ensuring effective handoff communication
(04:13):
significantly improves medication managementduring these critical transitions.
It's also essential to emphasize the importanceof interprofessional collaboration
and communication
among health care providers and their patientswhen the entire health care team works together.
Patient outcomesimprove in avoidable complications decrease.
Pharmacist led interventions have been shownto reduce avoidable hospital readmissions,
(04:35):
decrease medicationerrors and enhance overall patient care.
Some key interventionsinclude medication reconciliation or metric,
which is reviewing patient's medicationlist at admission during transition
and that discharge to identify discrepancies,prevent medication
errors and ensure continuity of carewhen conducting a medication.
Reconciliation of over the counter medicationsand herbals should also be included
(04:57):
in that medication evaluation.
Additionally, a second source, such as a patient'sprescription refill history or previous
medical records from another health care provider,should be utilized to ensure accuracy.
Patient and caregivereducation is another piece of this.
So providing guidance on medication regimens,
potential side effects and adherence strategiesto improve patients and caregivers
(05:18):
and managing medications correctly post-dischargecollaboration of health care teams.
By working closely with physicians, nursesand case managers to optimize medication
therapy, prevent adverse drug eventsand tailor treatments to individual patient needs.
Follow up calls or visits by conductingPost-Discharge follow ups to address medication
related concerns, reinforce adherence and identifycomplications early to prevent readmissions.
(05:40):
Targeted interventions for high risk populationsby providing intensified
pharmaceutical care for patients of complexmedication regimens or multiple calamities,
reducing hospital visitsand improving long term health care outcomes.
And finally, ultimately, pharmacistled interventions not only enhance
medication safety, but also play a vital rolein reducing hospital readmissions,
(06:01):
improving adherence and supporting betteroverall health care outcomes.
Thank you, Hailey, for the information.
Katie, can you give our listenersa high level overview of ISMP's New Best Practice
21 for 2024 & 2025, and how it aims to prevent
medication errors during transitions of care.
(06:21):
Of course, the Institute for Safe MedicationPractices or ISMP recognized
that medication discrepancies and incompleteor inaccurate information
are major contributorsto errors during transitions of care.
To addressthis ISMP has expanded its targeted medication
safety best practicesto include transitions of care.
(06:42):
The new strategies introduced in Best Practice 21
focus on preventing medication errorsacross the continuum of care,
and these include obtaining
the most accurate medicationlist possible upon admission before administering
the first dose of medication,except in emergencies or urgent situations.
(07:02):
Of course,the patient interview should include asking about
allergies and associated reactions,collecting information on prescription
and over-the-counter medications,including herbals and dietary supplements,
documenting non-controlled medicationssuch as injections, inhalers and patches,
and listing each medications name dose
(07:25):
frequency indication and time of disasters.
In addition to specifics regardingwhat should be obtained on the medication
list, ISMP providesthe following process related recommendations.
Organizationsshould assign dedicated practitioners
to obtain medicationhistories to ensure accuracy and consistency.
(07:46):
Those practitioners should verifythat the medication and doses collected
and subsequently prescribed are appropriatefor the patient's current health status.
A provider should also be designatedto compare prescribed medications
against the patient's medication historyand resolve any discrepancies.
This process should be documented thoroughly
(08:07):
with reconciliationand any modifications made at key transition
points such as upon admissionwith each change and level of care and discharge.
By implementing these best practices,
health care organizationscan significantly reduce the risk of medication
errors, ensuring safer and more effectivetransitions of care for patients.
(08:30):
Thank you, Katie.
To wrap up, let's shift gears to quality measures.
The Joint Commissionand the CMS have established key guidelines
that emphasize the importanceof effective transitions of care.
Hailey, can you share some key highlights?
Absolutely.
So the Joint Commission has identifiedseveral safety measures
that positively impact transitions of care,particularly in medication management.
(08:54):
So these include involvingpharmacists and metrics.
Whenever possible, pharmaciesplay a vital role on interdisciplinary teams
by conducting medication interventionsduring transitions of care.
This applies across all health caresettings, and studies estimate that for every $1
invested in a pharmacist timehealth care system save approximately $12.
Emphasizingthat safe, high quality transitions of care
(09:17):
crucial for accurate medicationmanagement and positive patient outcomes.
Each transition whether an admission, dischargeor between care settings, presents
an opportunity to enhance patient safetyand prevent medication errors.
Additionally, the CMS Hospital ReadmissionsReduction Program or HRRP, is a Medicare
value based purchasing initiative aimedat improving communication and care coordination.
(09:39):
Its goal is to better engagepatients and caregivers in discharge planning,
ultimately reducing preventablehospital readmissions.
One of the keymeasures of HRRP is the Excess readmission
ratio, or ERR, which assesses hospital
performance based on readmissionrates for certain high risk conditions.
Additionally, CMS penalizes hospitals with high30 day readmission rates for certain conditions,
(10:03):
and that's why hospitals prioritize pharmacistinvolvement and transitional care programs.
CMS also
provides various resources on care transitionsand medication management,
which are available
in their publications, for example,their transitional care management services,
chronic care management booklet, and the communitybased Care Transition Program, or CCTP
(10:25):
to help health care organizationsimprove patient outcomes and reduce readmissions
by prioritizing effective transitions of careand integrating pharmacist led interventions.
Health care providers can enhancepatient safety, optimized medication
management and reduce avoidablehospital readmissions.
Thank you, Hailey and Katiefor providing such valuable insights on pharmacist
(10:45):
led interventions during transitions of care,highlighting
the 2024 2025 ISMP Best Practice 21
and discussing the quality measuresby CMS in the Joint Commission.
In our next episode will be hostingLarissa Bethishou, a Transition of Care pharmacist
dedicated to improving medicationsafety and transition of care.
Best practices
(11:05):
will focus on strategies for preventing medicationerrors during transitions, with an emphasis
on medication reconciliation and effectivecollaboration across health care teams.
All right, to summarize major takeawaysfrom our time here
today, Pharmacist led interventions during
transitions of care can reduce hospitalreadmissions, minimize medication
errors, enhance overall healthcare outcomesand improve patient satisfaction.
(11:29):
Poor communications among health care providers,a lack of standardized processes and shifts
in patient acuityleave patients vulnerable to medication errors,
adverse drug events and unnecessaryhospitalization.
Addressing these gapsthrough structured processes is crucial.
Best practices such as ISMP
2024-2025 Best Practice 21 stressed the importance
(11:53):
of obtaining and verifying an accurate medicationhistory at every transition point.
Admission, level of care changesand discharge to ensure
continuity of care and prevent discrepancies.
All right, folks, that's all we have for today.
Look out for part two of this month's firstfull podcast that will be released next Thursday.
(12:13):
For those interested in transitions of care,we've just launched the BCGP
webinar series and APhA’s case studyrecertification series for 2025.
This month we're focusing on addressing socialdeterminants of health and transitions of care.
So don't miss it.
And last but not least, don'tforget to head over to the Learning Library
at learn.pharmacist.comto earn your see for this month's podcast.
(12:37):
We'd love to hear your feedback on how you likethe new set up.
Take care and goodbye.
Welcome to the First Fill.
My name is Yara Al Shaer and I serveas the executive fellow and education at APhA.
I'm very excited to be your host todayto discuss one of my favorite topics.
Today, we're focusing on a crucial aspectof pharmacy practice transitions of care,
where pharmacies play an essential rolein ensuring medication safety, preventing errors
and improving patient outcomes from conductingmedication, reconciliation, hospital admissions
(00:28):
and discharge to collaboratingwith health care teams and educating patients.
Pharmacists help prevent medicationrelated errors and reduce hospital readmissions.
Transition of care is more than just a process.
It's a patient safety priority that impactsoverall health care, quality and system
performance.
Before we dive in, I'd like to introduce my gueststoday, Katie and Hailey.
(00:51):
Katie and Hailey,why don't you introduce yourselves?
Thank you, Yara.
Hi, everyone. This is Katie Meyer.
I serve as the Senior Director of Content Creationat APhA, and I'm excited
to talk about this topic today with you.
Thanks for having me, Yara and Katie.
My name's Hailey.
I am the Senior manager of CustomEducation here at APhA.
(01:11):
Looking forward to this.
Well, welcome.
Excited to have you both here today.
A key focus of of our conversationtoday will be the ISMP Best Practice 21,
which outlines strategies for preventingmedication errors during transitions of care.
We will also explore how pharmaciescontribute to hospital performance metrics
by aligning with the Joint Commission and Centersfor Medicare and Medicaid Services.
(01:36):
These CMS quality measures, including medicationreconciliation and post-discharge interventions.
In part 2, I’ll welcome an expert in the field,Larissa Bethishou and we'll focus on strategies
for preventing medication errorsduring transitions of care, with an emphasis
on medication reconciliation and effectivecollaboration across health care teams.
(01:56):
So let's dive into today's discussionon how pharmacists can optimize
transition of care interventionsto enhance patient care and safety.
Katie, can you level set with our listenersabout what transitions of care entail,
the importance of involving pharmaciesand the prevalence of medication errors during
these transitions?
Of course, yeah.
(02:16):
So from a definition perspective,the term transitions of care refers
to the movement of a patientfrom one health care setting to another.
This could includenot only changes in levels of care, for example,
from the hospital to post acute rehab,but also changes in providers or services.
Evidence has demonstrated that poor communicationamong health care
(02:39):
providers, a lack of standardized processesand shifts in patient
acuity can leave patients vulnerable to medicationerrors during these care transitions.
While being discharged from the hospital is oftenseen as a positive step,
the process can be fraught with medicationrelated changes.
Patients may struggle with new prescriptions,unclear instructions
(03:02):
or unexpected costs that make their medicationsunaffordable every year.
Medication errors contribute to over 7000 deaths.
One study found that 30%
of patients experienced at least one medicationerror during transitions of care.
The good news
is that we as pharmacists,are well equipped to play a vital role in ensuring
smoother transitions, preventing those medicationerrors and improving patient outcomes.
(03:26):
Research has shownthat pharmacist led interventions during
transitions of care can reduce hospitalreadmissions, minimize medication
errors, enhance overall health care outcomesand improve patient satisfaction.
They also help decrease the inappropriateutilization of health care services,
reducing costs while improving outcomes.
(03:50):
Thank you, Katie.
Hailey, can you share with our audiencesome pharmacist led interventions
during transitions of care that have been shown
to improve patient outcomes and reduce readmissionrates?
Absolutely.
So pharmacists can play a crucial rolein transition of care.
Their interventions, such as medicationreconciliation, patient education,
identifying and addressing barriersand ensuring effective handoff communication
(04:13):
significantly improves medication managementduring these critical transitions.
It's also essential to emphasize the importanceof interprofessional collaboration
and communication
among health care providers and their patientswhen the entire health care team works together.
Patient outcomesimprove in avoidable complications decrease.
Pharmacist led interventions have been shownto reduce avoidable hospital readmissions,
(04:35):
decrease medicationerrors and enhance overall patient care.
Some key interventionsinclude medication reconciliation or metric,
which is reviewing patient's medicationlist at admission during transition
and that discharge to identify discrepancies,prevent medication
errors and ensure continuity of carewhen conducting a medication.
Reconciliation of over the counter medicationsand herbals should also be included
(04:57):
in that medication evaluation.
Additionally, a second source, such as a patient'sprescription refill history or previous
medical records from another health care provider,should be utilized to ensure accuracy.
Patient and caregivereducation is another piece of this.
So providing guidance on medication regimens,
potential side effects and adherence strategiesto improve patients and caregivers
(05:18):
and managing medications correctly post-dischargecollaboration of health care teams.
By working closely with physicians, nursesand case managers to optimize medication
therapy, prevent adverse drug eventsand tailor treatments to individual patient needs.
Follow up calls or visits by conductingPost-Discharge follow ups to address medication
related concerns, reinforce adherence and identifycomplications early to prevent readmissions.
(05:40):
Targeted interventions for high risk populationsby providing intensified
pharmaceutical care for patients of complexmedication regimens or multiple calamities,
reducing hospital visitsand improving long term health care outcomes.
And finally, ultimately, pharmacistled interventions not only enhance
medication safety, but also play a vital rolein reducing hospital readmissions,
(06:01):
improving adherence and supporting betteroverall health care outcomes.
Thank you, Hailey, for the information.
Katie, can you give our listenersa high level overview of ISMP's New Best Practice
21 for 2024 & 2025, and how it aims to prevent
medication errors during transitions of care.
(06:21):
Of course, the Institute for Safe MedicationPractices or ISMP recognized
that medication discrepancies and incompleteor inaccurate information
are major contributorsto errors during transitions of care.
To addressthis ISMP has expanded its targeted medication
safety best practicesto include transitions of care.
(06:42):
The new strategies introduced in Best Practice 21
focus on preventing medication errorsacross the continuum of care,
and these include obtaining
the most accurate medicationlist possible upon admission before administering
the first dose of medication,except in emergencies or urgent situations.
(07:02):
Of course,the patient interview should include asking about
allergies and associated reactions,collecting information on prescription
and over-the-counter medications,including herbals and dietary supplements,
documenting non-controlled medicationssuch as injections, inhalers and patches,
and listing each medications name dose
(07:25):
frequency indication and time of disasters.
In addition to specifics regardingwhat should be obtained on the medication
list, ISMP providesthe following process related recommendations.
Organizationsshould assign dedicated practitioners
to obtain medicationhistories to ensure accuracy and consistency.
(07:46):
Those practitioners should verifythat the medication and doses collected
and subsequently prescribed are appropriatefor the patient's current health status.
A provider should also be designatedto compare prescribed medications
against the patient's medication historyand resolve any discrepancies.
This process should be documented thoroughly
(08:07):
with reconciliationand any modifications made at key transition
points such as upon admissionwith each change and level of care and discharge.
By implementing these best practices,
health care organizationscan significantly reduce the risk of medication
errors, ensuring safer and more effectivetransitions of care for patients.
(08:30):
Thank you, Katie.
To wrap up, let's shift gears to quality measures.
The Joint Commissionand the CMS have established key guidelines
that emphasize the importanceof effective transitions of care.
Hailey, can you share some key highlights?
Absolutely.
So the Joint Commission has identifiedseveral safety measures
that positively impact transitions of care,particularly in medication management.
(08:54):
So these include involvingpharmacists and metrics.
Whenever possible, pharmaciesplay a vital role on interdisciplinary teams
by conducting medication interventionsduring transitions of care.
This applies across all health caresettings, and studies estimate that for every $1
invested in a pharmacist timehealth care system save approximately $12.
Emphasizingthat safe, high quality transitions of care
(09:17):
crucial for accurate medicationmanagement and positive patient outcomes.
Each transition whether an admission, dischargeor between care settings, presents
an opportunity to enhance patient safetyand prevent medication errors.
Additionally, the CMS Hospital ReadmissionsReduction Program or HRRP, is a Medicare
value based purchasing initiative aimedat improving communication and care coordination.
(09:39):
Its goal is to better engagepatients and caregivers in discharge planning,
ultimately reducing preventablehospital readmissions.
One of the keymeasures of HRRP is the Excess readmission
ratio, or ERR, which assesses hospital
performance based on readmissionrates for certain high risk conditions.
Additionally, CMS penalizes hospitals with high30 day readmission rates for certain conditions,
(10:03):
and that's why hospitals prioritize pharmacistinvolvement and transitional care programs.
CMS also
provides various resources on care transitionsand medication management,
which are available
in their publications, for example,their transitional care management services,
chronic care management booklet, and the communitybased Care Transition Program, or CCTP
(10:25):
to help health care organizationsimprove patient outcomes and reduce readmissions
by prioritizing effective transitions of careand integrating pharmacist led interventions.
Health care providers can enhancepatient safety, optimized medication
management and reduce avoidablehospital readmissions.
Thank you, Hailey and Katiefor providing such valuable insights on pharmacist
(10:45):
led interventions during transitions of care,highlighting
the 2024 2025 ISMP Best Practice 21
and discussing the quality measuresby CMS in the Joint Commission.
In our next episode will be hostingLarissa Bethishou, a Transition of Care pharmacist
dedicated to improving medicationsafety and transition of care.
Best practices
(11:05):
will focus on strategies for preventing medicationerrors during transitions, with an emphasis
on medication reconciliation and effectivecollaboration across health care teams.
All right, to summarize major takeawaysfrom our time here
today, Pharmacist led interventions during
transitions of care can reduce hospitalreadmissions, minimize medication
errors, enhance overall healthcare outcomesand improve patient satisfaction.
(11:29):
Poor communications among health care providers,a lack of standardized processes and shifts
in patient acuityleave patients vulnerable to medication errors,
adverse drug events and unnecessaryhospitalization.
Addressing these gapsthrough structured processes is crucial.
Best practices such as ISMP
2024-2025 Best Practice 21 stressed the importance
(11:53):
of obtaining and verifying an accurate medicationhistory at every transition point.
Admission, level of care changesand discharge to ensure
continuity of care and prevent discrepancies.
All right, folks, that's all we have for today.
Look out for part two of this month's firstfull podcast that will be released next Thursday.
(12:13):
For those interested in transitions of care,we've just launched the BCGP
webinar series and APhA’s case studyrecertification series for 2025.
This month we're focusing on addressing socialdeterminants of health and transitions of care.
So don't miss it.
And last but not least, don'tforget to head over to the Learning Library
at learn.pharmacist.comto earn your see for this month's podcast.
(12:37):
We'd love to hear your feedback on how you likethe new set up.
Take care and goodbye.
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