The Impact of Pharmacist Transitions of Care Interventions in Identifying Medications Errors for Patients Discharging to a Skilled Nursing Facility

<b>Background:</b> Patients being discharged from acute care facilities have a high risk of hospital readmission due to medication errors. Pharmacist interventions during transitions of care (TOC) may be beneficial in identifying medication errors and improving patient outcomes when discharging to a skilled nursing facility (SNF). <b>Objective</b> The objective of this study was to evaluate the impact of pharmacist interventions in reducing medication errors for patients being discharged from an acute care facility to a SNF. <b>Setting</b> A community hospital that is part of a larger health network in Southern California. <b>Practice Description</b> Clinical pharmacists provide TOC interventions to high-risk patients discharging home. <b>Practice Innovation</b> Over a three-month period, pharmacists provided TOC interventions to patients discharging from a hospital to a SNF. A retrospective chart review evaluated documented pharmacist interventions to identify and categorize medication errors based on the potential for harm. <b>Results</b> Pharmacists saw 324 patients being discharged from the hospital and identified a total of 33 medication errors. A total of 61% of errors were related to incorrect dose, frequency, or route of administration, while 51.5% had a capacity to cause temporary harm. Only 1 error could have necessitated intervention to sustain life. Ultimately, 76% of pharmacist interventions were accepted by the patients' physicians or health care teams. <b>Discussion</b> Pharmacists' interventions, in addition to communication with the health care team, were able to prevent medication errors with potential to cause harm as patients transitioned from a hospital to a SNF. <b>Conclusion</b> Pharmacists can support safe transitions for patients discharging from the hospital to the SNF.