CMAJ • September 14, 2004; 171 (6). doi:10.1503/cmaj.1040721.
© 2004 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters
Correspondance

Adverse events: past and future

Neil Johnson* and Myrella T. Roy{dagger}

*President, Canadian Society of Hospital Pharmacists, Ottawa, Ont.; {dagger}Executive Director, Canadian Society of Hospital Pharmacists, Ottawa, Ont.

Published evidence abounds on the role of hospital pharmacists in preventing adverse drug events and improving patient outcomes within hospitals.1,2,3 However, as the study by Alan Forster and colleagues4 demonstrates, many of the adverse medication-related events that patients experience occur outside the practice setting of hospital pharmacists.

The Canadian Society of Hospital Pharmacists promotes more seamless approaches to patient care and enhanced sharing of clinical information among hospital and community physicians and pharmacists. Use of a comprehensive electronic health record across multiple care jurisdictions can improve information flow and appropriate prescribing and monitoring of medications. Furthermore, many hospital pharmacists and physicians have implemented discharge prescription and communication tools (known variously as prescription/discharge notes form, discharge prescription form, pharmacy discharge letter and pharmacy discharge summary5,6,7) to enhance transfer of patient information to their primary care colleagues.

We hope that the evidence of the positive impact of hospital pharmacists1,2,3 will prompt implementation of similar models of interdisciplinary care in the broader health care community to improve patient outcomes and enhance the safety of our system.

Neil Johnson President Myrella T. Roy Executive Director Canadian Society of Hospital Pharmacists Ottawa, Ont.

Footnotes

Competing interests: None declared.


References

  1. Leape LL, Cullen DJ, Clapp MD, Burdick E, Demonaco HJ, Erickson JI, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit [published erratum appears in JAMA 2000;283(10):1293]. JAMA 1999;282(3):267-70.[Free Full Text]
  2. Bond CA, Raehl CL, Franke T. Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals. Pharmacotherapy 2002;22(2):134-47. [CrossRef][Medline]
  3. Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F, et al. Medication errors and adverse drug events in pediatric inpatients. JAMA 2001;285(16):2114-20. [Abstract/Free Full Text]
  4. Forster AJ, Asmis TR, Clark HD, Al Saied G, Code CC, Caughey SC, et al. Ottawa Hospital Patient Safety Study: incidence and timing of adverse events in patients admitted to a Canadian teaching hospital. CMAJ 2004;170(8):1235-40. [Abstract/Free Full Text]
  5. Zwicker LA, MacKinnon NJ. Documentation requirements for seamless care. MacKinnon NJ, editor. In: Seamless care: a pharmacist's guide to continuous care programs. Ottawa: Canadian Pharmacists Association; 2003. p. 73-86.
  6. Rogers K, Tierney M, Singh A, McLean W. Assessment of a seamless care prescription/discharge notes form. Can J Hosp Pharm 2003; 56:14-23.
  7. Grad R, Mallet L. Improving communication between hospitals and community providers: the role of a pharmacy discharge letter. Can J Hosp Pharm 1998;51:23-5.




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