The impact of pharmacy discharge planning on continuity of care.

Maintaining high quality patient care following hospital discharge is essential for complete recovery and continued well-being. Historically, pharmacist participation in discharge planning has been minimal and has been frequently limited to last minute patient counselling. Hospital pharmacists can contribute to the continuity of patient care by summarizing changes made to a patient's therapy, their rationale, and future considerations in a discharge report to the family physician and/or community pharmacist. In this study, pharmacy discharge summaries were prepared for inclusion in the discharge report to the family physician. Summaries were also forwarded to the community pharmacist, where appropriate. Two types of pharmacy summaries completed were "Rationale for Inpatient Changes" (RIC) and "Recommendations for Future Changes" (RFC) summaries. Evaluation forms accompanying the summaries elicited very favourable responses. An independent review group of two physicians and two pharmacists rated the potential for reduction of patient mortality/morbidity as either marked, modest, minor or negligible; most of the summaries were evaluated as having a "modest" impact. Workload associated with preparation of pharmacy summaries would require additional pharmacy staff. Direct and indirect cost savings, including decreased drug costs and avoidance of drug complications and hospital readmissions, are associated with this service.