The first coordinated national approach to addressing medication management issues at transitions of care (TOC) was recently launched.

The Australian Commission on Safety and Quality in Health Care published a national framework to support health services in reducing the vast number of medication-related errors and hospital readmission rates for patients who are transitioning between care settings.

In Australia, 250,000 hospital admissions annually are due to medication-related errors, at a cost of about $1.4 billion. More than 50 per cent of medication errors occur at transitions of care.

Dr Phoebe Holdenson Kimura, Medical Advisor for the Commission and a general practitioner, is the clinical lead for the TOC program of work.  She says the framework was developed over several years’ sector engagement with input from stakeholders working across hospitals, pharmacy, aged and primary care, as well as literature reviews which produced strategies to facilitate safer medication management and digital approaches to support safer Transitions of Care.

“There is a real opportunity for hospital clinicians to adopt the new Framework and take action to strengthen communication with the primary and aged care sectors,” Dr Holdenson Kimura said. “Medication error, and hospital readmission related to medication error, is still a significant problem and people are at particularly high risk when they’re transitioning between care settings.”

One aspect of the framework is to promote identification of patients at high risk for medication-related problems. This can include people who are aged over 65 years, take five or more medications or take a high-risk medication, and those with multiple prescribers for their medication.

Dr Holdenson Kimura told Pulse+IT: “In addition to this being a national priority for the Commission, the World Health Organization – through its global patient safety challenge – has identified medication management at Transitions of Care as one of three pillars that are of international importance.”

She said while a lot of hospitals have good systems in place to mitigate risk of medication error, the framework is designed to support better outcomes for patients wherever they move around the system.

“The Framework has been designed to be adapted to suit local hospital settings. We’re putting forward general principles and examples of how the approach could be implemented and giving flexibility to organisations in how to apply those principles.

“Safer Care Victoria are already doing a pilot across 19 hospitals. They will be evaluating it and seeing whether it is making a difference to patient outcomes. The Commission is keen for the Framework to be really meaningful for services.

“The Transition of Care framework is also relevant to the community sector, where the person is coming into the hospital environment and then discharged back to either the GP or the residential aged care facility,” Dr Holdenson Kimura said.

CORE ELEMENTS OF THE FRAMEWORK

Dr Holdenson Kimura said the first element was around establishing a governing committee for leadership, oversight and direction of the process outlined in the framework.

“We envisage that role to fit within an existing committee, say a medication safety committee or communicating for safety committee. So that committee has ongoing governance over the process.

“Element two is around the multidisciplinary stewardship team, and element three is around the medication management activities – including medication reconciliation, and regular medication review – articulating what’s happening on the ground for the patients who have been identified by the emergency department as being at higher risk.

“One of the most important aspects is around discharge planning. There needs to be proactive communication between the treating team and the general practice or the residential aged care facility, saying ‘this patient is going to be discharged soon. These are the medication changes that have been made for this reason’.  This allows for early medication reconciliation to be planned for and coordinated before the patient is discharged or has run into trouble.”

She said the fourth element is around the monitoring, evaluation and reporting of the framework.  “As hospitals design their own application of the framework and roll it out, they need to see if it is having the intended consequences and improvement. Then they can continue to make those tweaks to progress with quality improvement.”

DIGITAL INFRASTRUCTURE

Digital maturity will be a key factor in realising the full benefits of the framework.

“We feel strongly that while the implementation of the framework doesn’t depend solely on the availability of digital solutions, digital maturity is considered a key factor,” Dr Holdenson Kimura said.

“Across jurisdictions, across the hospital sector, primary care and residential aged care facility, there is quite a lot of variation in terms of digital maturity. 

“So we’re not being prescriptive about what systems need to be used, but recognising that over time, we do hope to see that the process of maturation is continuing to happen, to enable more accurate and more timely communication between care settings.

“The electronic health record – My Health Record, the online electronic repository where the individual and clinicians can access health information in a secure way – is continuing to mature and moving in a really great direction.

“That allows for multiple stakeholders to be able to look at – and access – one source of information. In the same vein, the digital platform within the individual health service organisation, the electronic medical record,  is an important enabler, so that prescribing, charting and dispensing functions work together.

“Data interoperability is another critical factor – the concept that the data coming out of the hospital discharge summary is coded in such a way that it can be accessed and utilised by practice software, to streamline things for the clinicians.

“The Commission already does a lot of work with discharge summaries, and we will be releasing revised standards for the electronic discharge summaries. If we can standardise the content of those, it again helps with the use of that data by other practitioners.”

She said the new framework aligned with the National Digital Health Strategy 2023-2028 and National Healthcare Interoperability Plan.

“It would be fantastic to see the different elements all working effectively as a harmonised approach, so that the digital communication is something that happens by default, and happens well,” Dr Holdenson Kimura said.