Reducing medication errors at transitions of care is everyone’s business

Abstract

Medication errors are a common and significant problem, particularly when patients transition between healthcare providers. Discrepancies are especially prevalent on hospital admission and discharge. People with complex medication regimens, older people, those with mental health problems, people who are poor or have low literacy, and Aboriginal and Torres Strait Islander and migrant populations are particularly at risk of medication discrepancies. A patient-centred approach is a necessary shift towards reducing medication discrepancies and errors. The patient is the one ‘constant’ as they progress through GP and ancillary primary care services, hospital services, and specialist outpatient and private clinics. Patients and their carers need to be involved as active participants in this process. Maintaining an accurate, comprehensive and up-to-date medicines list that follows the patient, reduces serious medication error. Pivotal to this record is a medicines reconciliation review at error-prone transition points. Multiple health professionals involved in a patient’s journey through healthcare services need to embrace accountability for medicines-related outcomes. Emerging technologies for communication between primary care and specialist or secondary services will facilitate this, but importantly, there needs to be commitment from each health professional to undertake this approach.