Introduction

Medication errors frequently occur when the patient is admitted or discharged from the hospital, i.e. when the patient switches from the ambulatory care sector to the hospital sector and vice versa. Different types of national healthcare systems in Europe may enhance or aggravate the probability of medication errors at the ambulatory-hospital care interface, but the ideal medication use system is not yet established. Often physicians and pharmacists practising in different sectors of the healthcare system are governed by differing formulary systems, differing reimbursement systems or differing organisational cultures. The more the healthcare sectors are separated, the more difficult will it be to manage safe prescribing and help people making the best use of medicine.

The ambulatory-hospital care interfaces are difficult to handle as they are error prone and affect patient safety. Seamless care is the desirable continuity of care delivered to a patient in the healthcare system across the spectrum of caregivers and their environments. The aim of seamless pharmaceutical care is to optimize medication therapy management, to minimize medication errors at the ambulatory-hospital care interface, and thereby to improve patients’ quality of life. The patient’s overall needs and desired outcomes and other health professionals’ assessments, goals, and therapy plans should be considered in determining the pharmaceutical care plan.

Hospital pharmacists should be involved in taking drug therapy histories, medication reconciliation, drug therapy monitoring during hospital stay, verification of the discharge medication and patient education and counselling regarding the discharge medication. Local pharmacists should provide information, education, and counselling to patients about their medication during ambulatory treatment. Relevant issues about the medication therapy and any barriers to patient compliance should be communicated between pharmacists working in the different health care sectors and other team members. In some countries the clinical pharmacy staffing is poor, so there might be only a poor impact on the process by this very specialised group. Electronic systems for targeted pharmacist-conducted admission and discharge medication reconciliation could be a help, but there are only few validated systems in place. In this key note lecture it will be shown which profession is engaged at which point of interface, which technical aids are in place and what the future will show to best handle those interfaces to ensure patient safety and best practice.

Teaching goals:

• to discuss the process of seamless care in general
• to define the problems of seamless care in different European countries
• to define the type of medication errors and resulting risks at the ambulatory-hospital care interface
• to discuss potential pharmaceutical interventions and interdisciplinary cooperation at the ambulatory-hospital care interface
• to show the impact of the hospital pharmacist on patient outcome
• to show the impact of the hospital pharmacist on patient outcome by practising pharmaceutical care at the ambulatory-hospital care interface

Learning objectives:

Participants should be able to:

• define the term seamless care
• summarise the tasks of the hospital pharmacist in the field of seamless care
• summarise study results which show the impact of the hospital pharmacist in this field
• summarise outcome parameters of seamless care