Improving Transitions of Care


by Patti J. Brown, M.D.

Physical Medicine and Rehabilitation Medical Director, HealthSouth Reading Rehabilitation Hospital

It is that time of year again. Our hospital’s Joint Commission Accreditation is due and we are reviewing Patient Safety Goals. When reviewing the goals it is easy to see the true meaning and purpose behind them. Acute Rehabilitation hospitals are licensed as acute care hospitals and are subject to the same rules as acute care hospitals. The patient safety goal of medication reconciliation has been easy to embrace at rehabilitation hospitals. An accurate list of the patient’s medication is imperative to good transitions of care.

Dr-Brown-InsideMedication reconciliation is the ongoing process of documenting appropriate medication orders at each transition of care. Since HealthSouth Reading is a post-acute facility this involves an extra step. We must first determine the patient’s medication use at home. We then review medication changes made at the acute care hospital and, with the patient’s and family’s input, determine a medication list which is appropriate for the patient at our facility.

At the time of discharge from the rehabilitation hospital, another medication reconciliation is performed. The process consists of again determining what medication the patient has at home, reconciling changes made at the acute care hospital with changes made at the rehabilitation hospital, and the final step of determining medication orders for discharge.. The patient must be given prescriptions for new medications and instructed to get rid of medications they are no longer on. An accurate list is then forwarded to the primary care physician to ensure the continuum of care.

The process sounds complicated and it is. Rehabilitation hospitals have a long history of using the team approach to provide good care to our patients, and medication reconciliation is a good use of that approach. The patient and patient’s family is involved in every step and the pharmacist and nurse can help in obtaining accurate lists. But ultimately the responsibility of appropriately ordering medication and discharging patients on the appropriate medication is the responsibility of the physician. Therefore it is important for the physician to be involved at every step. The pharmacist or nurse may assist physicians in the medication reconciliation process, but it is the responsibility of the physician to know how the lists are obtained.

The electronic medical record has helped and hindered this process. In many cases the lists of discharge medications are maintained in the system. The difficulty arises if changes are made outside of the system and not incorporated at the next episode of care. It is also too tempting to push the button “resume all meds” at discharge, not taking into account changes that have been made during the hospitalization.

Hospitals, post acute hospitals, post acute agencies and physicians should embrace medication reconciliation. It is one of the most important aspects in patient care and deserves the time and effort spent by physicians in ensuring a good process.

The medication reconciliation process is the step that ensures the good care you give your patients translates into a manageable, appropriate, and affordable plan at discharge. Please review Ms. Morrison’s article in this issue. She has done an excellent analysis of the problems our patients face at home. She points out the importance of educating our patients each step of the way and the importance of in-home follow-up. Good patient care and assuring good outcomes are the responsibilities of the entire healthcare team.

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