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Discontinuities, Gaps, and Hand-Off Problems
PATIENT SAFETY PRIMERS
Adverse Events after Hospital Discharge
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Discontinuities, Gaps, and Hand-Off Problems
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NEWSPAPER/MAGAZINE ARTICLE
Survey results: community liaison programs to decrease hospital readmissions.
ISMP Medication Safey Alert! Acute Care Edition. March 7, 2013;18:1-3.
TOOLKIT
Med List.
Massachusetts Coalition for the Prevention of Medical Errors, Betsy Lehman Center for Patient Safety and Medical Error Reduction, Massachusetts Medical Society.
NEWSPAPER/MAGAZINE ARTICLE
Practitioners agree on medication reconciliation value, but frustration and difficulties abound.
ISMP Medication Safety Alert! Acute Care Edition. July 13, 2006;11:1-2.
NEWSPAPER/MAGAZINE ARTICLE
Manic for medication safety: bar codes and drug information databases are helping to reduce medication errors.
Rogoski RR. Health Manage Technol. February 2007;28:14, 16-18.
STUDY
Medication reconciliation for reducing drug-discrepancy adverse events.
Boockvar KS, Carlson Lacorte H, Giambanco V, Fridman B, Siu A. Am J Geriatr Pharmacother. 2006;4:236-243.
COMMENTARY
Medication reconciliation physician order form.
Lacy JL, Wilkinson ST. Hosp Pharm. 2006;41:1117-1120.
COMMENTARY
Improving care transitions: current practice and future opportunities for pharmacists.
American College of Clinical Pharmacy, Hume AL, Kirwin J, et al. Pharmacotherapy. 2012;32:e326-e337.
COMMENTARY
Citrate Mix-Up
Weber RJ. AHRQ WebM&M [serial online]. May 2006.
NEWSPAPER/MAGAZINE ARTICLE
JCAHO tightens leash on medication reconciliation.
Perry LE. Drug Topics: Health-System Edition. March 20, 2006.
STUDY
Improving medication reconciliation in the outpatient setting.
Varkey P, Cunningham J, Bisping S. Jt Comm J Qual Patient Saf. 2007;33:286-292.
BOOK/REPORT
Medication Reconciliation Handbook.
Oakbrook Terrace, IL: Joint Commission Resources and the American Society of Health-System Pharmacists; 2006. ISBN: 0866889566.
NEWSPAPER/MAGAZINE ARTICLE
Accuracy at every step: the challenge of medication reconciliation.
Institute for Healthcare Improvement Web site. March 20, 2006.
STUDY
Effectiveness of a pharmacist–nurse intervention on resolving medication discrepancies for patients transitioning from hospital to home health care.
Setter SM, Corbett CF, Neumiller JJ, Gates BJ, Sclar DA, Sonnett TE. Am J Health Syst Pharm. 2009;66:2027-2031.
NEWSPAPER/MAGAZINE ARTICLE
Discharge missteps can send seniors back to hospital.
Korc B, Landers SJ. American Medical News. February 15, 2010.
STUDY
Implementation of an electronic system for medication reconciliation.
Kramer JS, Hopkins PJ, Rosendale JC, et al. Am J Health Syst Pharm. 2007;64:404-422.
STUDY
Multidose drug dispensing and discrepancies between medication records.
Wekre LJ, Spigset O, Sletvold O, Sund JK, Grimsmo A. Qual Saf Health Care. 2010;19:e42.
STUDY
Medication report reduces number of medication errors when elderly patients are discharged from hospital.
Midlöv P, Holmdahl L, Eriksson T, et al. Pharm World Sci. 2008;30:928-1231.
COMMENTARY
Electronic Err.
Tang PC. AHRQ WebM&M [serial online]. October 2004.
NEWSPAPER/MAGAZINE ARTICLE
The five rights: a destination without a map.
ISMP Medication Safety Alert! Acute Care Edition. January 25, 2007;12:1.
BOOK/REPORT
Medication Management: Detailed Use Case.
Washington DC: Office of the National Coordinator for Health Information Technology, US Department of Health and Human Services; June 18, 2007.
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