CHPPC Module 15: Transitions of Care & Discharge Med Rec Intro
Part 4: Professional Integration & Operational Mastery

Module 15: Transitions of Care & Discharge Med Rec

Welcome to the module where your expertise as a community pharmacist becomes your most powerful asset. Transitions of care—the movement of patients between settings—are universally recognized as the most vulnerable points for medication errors. This module will build upon your deep, instinctual knowledge of medication reconciliation and patient counseling, re-framing those skills for the high-stakes handoffs that define the hospital admission and discharge process. You will become the master of the handoff, ensuring every patient’s medication regimen is accurate, appropriate, and understood at every step of their journey.

From Anchor Point to Expert Navigator: Mastering the Handoff

In your community practice, you are the anchor point of medication continuity. You are the stable repository of a patient’s medication history, often for years. You see the changes, you know the prescribers, and you are the consistent expert patients rely on. Your role is defined by stability and longitudinal oversight.

In transitions of care, your role evolves from a stable anchor into an expert navigator guiding a ship through a series of complex locks. The patient’s admission is the entry into the first lock; their hospital stay is the turbulent passage; and their discharge is the final gate back to the open water of the community. At each gate, the water level changes, the pressures shift, and a mistake in the process can be disastrous. You are the harbor pilot who ensures the “baton” of the medication list is passed flawlessly from one team to the next, from one setting to another.

This module is designed to make you that expert navigator. It will provide the frameworks, communication strategies, and clinical workflows to manage these transitions with precision, transforming the points of highest risk into opportunities for profound pharmacist-led improvements in patient safety.

What This Module Will Teach You

This module provides a comprehensive, end-to-end masterclass on the pharmacist’s role in ensuring medication safety during every transition of care.

Admission Med Rec

You will learn the investigative techniques to create the “Best Possible Medication History” (BPMH), serving as the foundational document for the patient’s entire hospital stay and preventing errors at their source.

Inpatient Therapy Continuity

We will explore your role in reviewing and reconciling orders at internal transitions of care (e.g., floor to ICU), ensuring that home medications are appropriately continued or held, and preventing the propagation of errors within the hospital.

Discharge Simplification & Reconciliation

You will learn the art of creating a safe and comprehensible discharge medication regimen. We will cover strategies for simplifying complex regimens, eliminating unnecessary drugs, and performing a final reconciliation to ensure a flawless plan.

“Meds-to-Beds” Counseling

This section provides a deep dive into the gold standard of discharge counseling. You will master the “teach-back” method and other techniques to ensure patients and caregivers understand their medications, transforming the discharge moment into a powerful educational opportunity.

Community Handoff Best Practices

The transition doesn’t end when the patient leaves. You will learn the best practices for communicating critical medication changes and treatment plans to the next providers in the chain of care: the patient’s community pharmacist and their primary care physician.