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Lost in Transition: Medication Errors at the Time of Hospital Admission, Transfer, and Discharge

Lost in Transition: Medication Errors at the Time of Hospital Admission, Transfer, and Discharge

Teaser: 

Edward Etchells,MD, MSc, FRCP, Division of General Internal Medicine and Patient Safety Service, Sunnybrook & Women’s College Health Sciences Centre; Associate Professor, Department of Medicine, University of Toronto,Toronto, ON.
Tasnim Vira, BScPhm, Medical Student, Faculty of Medicine,University of Toronto, Toronto, ON.
Vincent C.Tam,MD, BSc(Hon), Internal Medicine Resident, Department of Medicine, McMaster University, Hamilton, ON; Thunder Bay, ON.

Medication errors at the time of acute care transition (admission, transfer, and discharge) are common. Health care providers can reduce these errors by obtaining an insightful medication history, documenting medication changes in medication orders and on discharge prescriptions, and promoting close teamwork among physicians, nurses, and pharmacists. The patient and family can also play an active role in reducing these errors. Medication reconciliation is a method for identifying and rectifying medication errors at transition. Reconciliation is a safe medication practice promoted by the Safer Healthcare Now campaign and is an accreditation requirement by the Canadian Council on Health Services Accreditation (CCHSA). Debates about the need for better studies examining the impact of reconciliation are ongoing.
Keywords: medication error, patient safety, hospital admission, discharge, transfer.