Further to the landmark work of Alan Forster and coauthors1 at the Ottawa Hospital–Civic Campus in identifying levels of adverse events at discharge and revealing the extent of the gap in continuity of care, particularly drug management, I wish to point out measures that have been taken in this region to diminish the problem.
In 1995 a group of Ottawa-area health care professionals — hospital and community pharmacists, physicians and a nurse — gathered to promote solutions to the gaps in seamless care.2 We recommended 2 major innovations: pocket drug profiles to be used by community pharmacists for patients receiving long-term medication, as well as formal discharge communications from the hospital to the family physician and the community pharmacist. The latter recommendation was instituted the next year at the Ottawa General Hospital (now the Ottawa Hospital–General Campus) in a form called “Prescription and Discharge Notes,” which provided complete information on discontinued medications, medication incidents and recommendations for ongoing care. A pilot project was instituted on a surgical floor, and a chart review followed. The review indicated that on average half of each patient's medications were changed before discharge and that potentially 61% of the discharge forms reported drug-related problems, only half of which were resolved before discharge.3 A later study on a medical floor showed an even greater number of changes and potential drug-related problems.4
This form has now been updated and its use extended to the Civic Campus and to other institutions. A further study showed that use of the form on the medical ward of a Montreal hospital increased the accuracy of patient profiles maintained by community pharmacists.5 It would be interesting to determine if this form makes a difference in the negative outcomes that Forster and coauthors1 so clearly identified.
Many other communities across Canada have tackled this problem, as revealed by posters and presentations at 2 national seamless care workshops.6,7The report by Forster and coauthors clearly demonstrates the need for pharmacists, physicians and others to mend the gap in communications between institutional and community care.
William McLean Pharmaceutical Outcomes Research Unit Ottawa Hospital — General Campus Ottawa, Ont.
Footnotes
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Competing interests: None declared.