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I read with interest Alan Forster's article on preventing adverse drug events after hospital discharge.1 In the 2 cases he outlines, it is likely that the involvement of a hospital pharmacist would have helped to prevent the adverse outcomes described.
The pharmacists in our small community hospital, which serves a largely geriatric population, offer a service that helps to minimize some potential problems with medications at discharge. For many patients, the pharmacists create a “discharge medication profile,” which is reviewed with the patient or their family members or both at discharge. These profiles are typically provided for patients who take more than 5 medications on a chronic basis, for whom several new medications have been prescribed, or whose medication types and dosages have been changed during their hospital stay.
To create the profile, the pharmacist completes a table that includes all current medications, directions, times to take each medication, the medical condition for which each medication is prescribed and any special instructions, all in easy-to-understand language. The pharmacist ensures that the patient has any new prescriptions that are required and will contact the prescribing physician if the prescriptions have not yet been written. The pharmacist also informs the patient which medications he or she should stop taking or take differently at home. The pharmacist may liaise with the patient's community pharmacist to arrange dosette or blister packing or to update him or her about medication changes.
The discharge medication profile is an accurate and legible medication list that can be used by other health care providers, such as home care nurses and community pharmacists. A copy is sent to the patient's general practitioner so that he or she also has a summary of the patient's medications at discharge.
REFERENCE
- 1.