Improving medicines safety at transitions of care

Case scenario

Amra, 80 years old and a regular patient of yours, has been discharged from hospital after an admission for a fall. She presents at the pharmacy with a bag of medicines and hands you a discharge medicines list. She appears to have been initiated on some new medicines in hospital and expresses confusion on which of her pre-hospital medicines to continue. You view her dispense history and My Health Record and notice discrepancies. It is unclear to you or Amra why some medicines have been initiated. She has an appointment with her GP in a couple of days.

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Medicines safety during transitions of care

The Australian Commission on Safety and Quality in Health Care (ACSQHC) defines transitions of care as the period when all or part of a person’s healthcare is transferred between care providers or care settings.¹

Transitions of care are periods of high risk for medication errors and miscommunication, leading to patient harm. When medicines safety is not prioritised at transitions of care, the risk of adverse events is increased, such as readmission to hospital and adv