Background: Discrepancies in patient’s medication list can lead to medication errors which is a major cause of both morbidity and mortality today. The aim of the study was to examine the frequency of discrepancies in the Swedish prescription list “My saved prescriptions” regarding noncurrent treatment, incorrect dosages, double prescriptions, and missing prescriptions. Additionally, the purpose was to examine the type of source of information the patients used regarding their drug treatment.   Methods: Collection of data was conducted through interviews at three different pharmacies over a period of four weeks in Stockholm 2020. Patients 18 years or older with at least three prescribed drugs were asked to participate in the study.   Results: Of 157 patients, 74 patients were included. More than 70% of the patients had one or more discrepancies in their prescription list: a noncurrent, a duplicate or an incorrect dosage. 17.6% had at least one missing prescription. About half of the patients had a noncurrent prescription, which was the most common discrepancy among the patients. More than a third, 35.1%, of the patients used the prescription list as a source of information for their drug treatments. Furthermore, 31.1% of the patients used the drug packaging and 17.6% of them only used their memory. 10.8% of the patients used the medication list from healthcare.  Conclusions: The results suggest that discrepancies were quite common in the prescription list, which can increase the risk of medication errors for patients who use the prescription list as a source of information. The implementation of the Swedish National List (NLL) (launching in 2021) will provide the caregivers, pharmacies, and patients with access to the same information about patient’s prescribed drugs. NLL will hopefully reduce the risk of medication errors and it should lead to a reduced necessity of using several different sources for prescribed drugs.

Parkinson' Disease (PD) is a motor disorder characterized by rigidity, tremor, and hypokinesia with secondary manifestations like defective posture and gait, mask like face and dementia. Over the years it may lead to inability to move, breath and ultimately patient may succumb to chest infection and embolism. Prevalence studies show that more than six million people around the world suffer from PD. At present, there is no cure for PD but there are effective treatments that can slow the progression of the disease and regulate its affects. PD results from a deficiency of dopamine so most drugs that produce a salutary effect in PD either potentiate dopamine or work as dopamine agonists. Hence, to keep the symptoms of PD to a minimum it is very important that the medications be consumed regularly, so that the dopamine level is maintained in the body of the subject. Electronic pillbox logger is a device that has been designed to ensure this very much required medication adherence in PD subjects, which can also be used to measure the response to oral medication. This work describes the design and implementation of an electronic pillbox logger for use by people suffering from Parkinson's disease (PD). The pillbox logger is designed to track medication adherence and prompt the user to take medication on time. It is pocket-sized, portable, and compartmented. It has a variety of alarm systems to remind the user to take the correct dose of their medication at the correct time. Most importantly, it keeps an electronic log of the time of dosage consumption by detecting the presence/absence of pills in the pillbox. This overcomes major limitations of other pillboxes with a logging function that are often too large to carry, contain a single compartment, or only record the time the container was opened rather than the presence or absence of pills. The proposed pillbox logger complements a wearable device under development for people with Parkinson's disease that continuously monitors impaired movement. The combination of the pillbox logger with the wearable sensor will permit clinicians to determine the response to oral therapies, which can be used to optimize therapy. People with PD consume similar pills throughout the day hence the pillbox logger has been designed to detect the presence/absence of pills in general in the pillbox rather than which specific pills are absent or present in the pillbox logger. This feature of the current design that the device records knowledge about pills in general in the pillbox logger and not about any specific pills is a major reason why the current design is specific to PD subjects only. However, though the current design of the pillbox logger is designed for people with Parkinson's Disease, the pillbox is suitable for other maladies in which the timing of the medication is critical. The described pillbox logger was built and the design was validated after running a number of tests. The battery powered pillbox logger is able to accurately store the information about the actual presence/absence of pills in each compartment of the pillbox. It is capable of sending out reminder alarms at the right time of the day and can be connected to a host computer using a USB cable to read the stored information from it. The proper functional working of the pillbox logger after thorough testing proves that the design of pillbox logger was successful.

Läkemedel är förknippat med stora risker inom hälso- och sjukvården. Patienter inom intensivvården löper dessutom högre risk att utsättas för läkemedelsfel då de erhåller många fler läkemedel jämfört med patienter på vårdavdelningarna. Då läkemedelsrelaterade vårdavvikelser ökat på den studerade intensivvårdsavdelningen genomfördes ett förbättringsarbete för att öka patientsäkerheten inom läkemedelshanteringsprocessen. Det övergripande målet för förbättringsarbetet var att minimera risken för att patienter ska drabbas av en läkemedelsrelaterad vårdskada genom att utveckla arbetssätt som främjar en säker läkemedelshanteringsprocess för sjuksköterskorna på intensivvårdsavdelningen. Som SMART mål sattes att antal läkemedelsrelaterade vårdavvikelser per månad skulle minska med 60%. Studiens syfte var att förklara förhållanden som påverkar införandet av de förändrade arbetssätten. Förbättringsarbetet genomfördes med utgångspunkt i Nolans förbättringsmodell. Den vetenskapliga fallstudien hämtade sitt empiriska material från fokusgruppsintervjuer med sjuksköterskorna på intensivvårdsavdelningen. Studiematerialet analyserades med hjälp av en tematisk analysmodell. Förbättringsarbetets SMARTa mål nåddes inte. Faktorer som påverkade införandet av förändrade arbetssätt var bl.a. motivation och ökad medvetenhet hos medarbetarna samt kunskapsförmedling och förbättringsteamets tillgänglighet. Trots att förbättringsarbetets mål inte nåddes vittnar fokusgruppsintervjuerna om att vissa kulturförändringar skett och att läkemedelshanteringsprocessen underlättats något. Att underlätta det dagliga arbetet så att så mycket som möjligt går bra är bl.a. det som utmärker Säkerhet-II-perspektivet. / Medications are associated with great risks in healthcare. Patients in intensive care are also at higher risk of being exposed to medication errors as they receive many more medications compared with patients in the wards. As medication errors increased in the studied intensive care unit, a quality improvement project was carried out to increase patient safety in the medication management process. The main goal of the quality improvement project was to minimize the risk of patients suffering from an adverse drug event by developing routines that promote a safe medication management process for the nurses in the intensive care unit. The SMART goal was to reduce the number of medication errors per month by 60%. The purpose of the study was to explain conditions that influence the introduction of the changed routines. The quality improvement project was carried out on the basis of Nolan´s improvement model. For the scientific case study empirical material was collected through, focus group interviews with the nurses in the intensive care unit. The study material was analyzed using a thematic analysis model. The SMART goal of the quality improvement project was not achieved. Factors that influenced the introduction of changed routines were e.g. motivation and increased awareness among the nurses as well as knowledge transfer and the improvement team´s availability. Despite the fact that the goal of the quality improvement project was not achieved, the focus group interviews testify that certain cultural changes have taken place and that the medication management process has been facilitated somewhat. To facilitate the daily working processes so that as much as possible goes well is something that characterizes the Safety-II-perspective.

No description available.

This study aimed to evaluate the use of a shared electronic primary health care record (EHR) to assist with medicines reconciliation in the hospital from admission to discharge. Methods: This is a prospective cross-sectional, comparison evaluation for 2 phases, in a short-term elderly admissions ward in the United Kingdom. In phase 1, full reconciliation of the medication history was attempted, using conventional methods, before accessing the EHR, and then the EHR was used to verify the reconciliation. In phase 2, the EHR was the initial method of retrieving the medication history-validated by conventional methods. Results: Where reconciliation was led by conventional methods, and before any access to the EHR was attempted, 28 (28%) of hospital prescriptions were found to contain errors. Of 99 prescriptions subsequently checked using the EHR, only 50 (50%) matched the EHR. Of the remainder, 25% of prescriptions contained errors when verified by the EHR. However, 26% of patients had an incorrect list of current medications on the EHR. Using the EHR as the primary method of reconciliation, 33 (32%) of 102 prescriptions matched the EHR. Of those that did not match, 39 (38%) of prescriptions were found to contain errors. Furthermore, 37 (36%) of patients had an incorrect list of current medications on the EHR. The most common error type on the discharge prescription was drug omission; and on the EHR, wrong drug. Common potentially serious errors were related to unidentified allergies and adverse drug reactions. Conclusions: The EHR can reduce medication errors. However, the EHR should be seen as one of a range of information sources for reconciliation; the primary source being the patient or their carer. Both primary care and hospital clinicians should have read-and-write access to the EHR to reduce errors at care transitions. We recommend further evaluation studies.

Bakgrund: Läkemedelshanteringsfel är en ledande orsak till patientskador i hälso- och sjukvårdssystem över hela världen och utgör ett betydande hot mot patientsäkerheten. Läkemedelshanteringsfel är mer vanligt förekommande på intensivvårdsavdelningar än på lägre vårdnivåer. Det dominerande sättet att arbeta med patientsäkerhet inom hälso- och sjukvård är genom avvikelserapportering och analysering av negativa händelser. Vid efterföljande analys och uppföljning av negativa händelser kan en förbättrad patientsäkerhet uppnås. Syfte: Att beskriva innehållet i de avvikelser beträffande läkemedelshanteringsfel, som rapporterats in på en intensivvårdsenhet under år 2023. Metod: En retrospektiv registerstudie. Datamaterialet analyserades med beskrivande statistik och kvalitativ manifest innehållsanalys. Resultat: Fem kategorier framkom under analysförfarandet: Hållbarhet, ordination, iordningställande, administrering och dokumentation. I kategorin administrering identifierades flest avvikelser. Slutsats: Resultatet i denna studie visar övergripande att ingen avvikelse ledde till en vårdskada men att samtliga var undvikbara. Den kategori som innehöll flest avvikelser var Administrering vilket är ett fynd som stärks av tidigare forskning som visar på att administreringsfasen är den mest kritiska i läkemedelshanteringen. Varför avvikelserna inträffade vore intressant att få svar på, något som kan ges som förslag till vidare forskning. Forskare inom säkerhet hävdar dock att det inte alltid är helt lätt att förstå orsakerna eftersom hälso- och sjukvården är ett komplext sociotekniskt system. / Background: Medication errors are a leading cause of patient injury in healthcare systems worldwide and represent a significant threat to patient safety. Medication errors are more common in intensive care units than at lower levels of care. The dominant way of working with patient safety in healthcare is through deviation reporting and analysis of negative events. In subsequent analysis and follow-up of adverse events, improved patient safety can be achieved. Aim: To describe the content of the deviations regarding medication handling errors, which were reported to an intensive care unit during the year 2023. Method: A retrospective registry study. The data material was analyzed with descriptive statistics and qualitative manifest content analysis. Results: Five categories emerged during the analysis procedure: Durability, prescription, preparation, administration and documentation. Most incident reports were identified in the category administration. Conclusion: The results of this study show overall that no deviation led to a medical injury, but that all were avoidable. The category that contained the most deviations was Administration, which is a finding that is reinforced by previous research that shows that the administration phase is the most critical in drug management. Why the deviations occurred would be interesting to get an answer to, something that can be given as a suggestion for further research. However, security researchers argue that it is not always easy to understand the causes because healthcare is a complex socio-technical system.

Atualmente a maioria das instituições vem buscando a qualidade da assistência, a segurança dos pacientes e o gerenciamento de riscos nos serviços de saúde, a fim de proporcionarem uma assistência livre de riscos e danos, o que pressupõe que incidentes sejam analisados para prevenir sua ocorrência. Trata-se de um estudo do tipo exploratório, cujo objetivo foi analisar dois tipos de incidentes relacionados à segurança do paciente, na assistência de enfermagem, que foram notificados em um hospital geral e privado, do interior do Estado de São Paulo, no período de janeiro a março de 2012, por meio da metodologia da Análise de Causa Raiz. Dessa forma, o universo em estudo foi constituído por 62 incidentes relacionados à segurança do paciente, sendo 11 quedas e 51 erros de medicação notificados. A pesquisa foi realizada em duas fases, sendo que, na primeira fase, os dados dos formulários de notificação e dos prontuários dos pacientes foram transcritos para o instrumento de coleta de dados. Na segunda fase, incidentes relacionados à segurança dos pacientes e que causaram danos, em relação às quedas, ou que tinham potenciais, no caso dos erros de medicação, foram submetidos a essa análise. Assim, 82,3% dos incidentes notificados foram erros de medicação, e 17,7% foram quedas. A maioria dos incidentes ocorreu nas alas de internação, e a equipe de enfermagem se envolveu em 78,5% dos incidentes. Os erros de omissão (31,5%), de horário (22,2%), de técnica de administração (14,8%) e de dose (14,8%) foram os principais tipos de erros de medicação ocorridos. O custo das quedas foi R$ 91,88 e dos erros de medicação foi R$ 1.188,43. Os eletrólitos, antimicrobianos e analgésicos foram os principais medicamentos envolvidos nos erros de medicação. Com relação aos fatores causais das quedas analisadas, 25,7% foram relacionadas à categoria paciente, 22,9%, à equipe, 17,1%, ao ambiente, 14,3%, à tarefa, 11,4%, ao indivíduo e 8,6%, à gestão. Um total de 83 causas contribuiu com a ocorrência dos erros de medicação, sendo que a categoria gestão contribuiu com 32,6% dos erros, indivíduo com 21,7%, equipe com 19,3%, ambiente com 12,0%, tarefa com 9,6% e paciente com 4,8%. Posteriormente, recomendações para evitar a ocorrência desses incidentes na instituição, focando as melhores práticas, foram propostas. / Presently, most institutions have sought care-provision quality, patient safety and risk management in health care services so as to provide risk- and damage-free caregiving, which presupposes that incidents should be analyzed in order to prevent their occurrence. This is an exploratory study the objective of which was to analyze two types of patient-safety-related incidents occurring during nursing care at a general private hospital in São Paulo state from January to March 2012 by means of the Root Cause Analysis Methodology. Hence, the universe under study consisted of 62 patient-safety-related incidents, of which 11 were falls and 51 were reported medication errors. The study was conducted in two phases, and in the first phase, the data on report forms and on patients\' medical records were transcribed to the data collection instrument. In the second phase, the patient-safety-related incidents that caused harm in relation to falls or those that were potentially harmful in the case of medication errors were analyzed. Hence, 82.3% of the reported incidents were medication errors, and 17.7% were falls. Most of the incidents occurred in the hospitalization wards, and the nursing staff was involved in 78.5% of the incidents. Omission (31.5%), time (22.2%) administration-technique (14.8%) and dose (14.8%) errors were the major medication-error types that occurred. The cost of falls was R$ 91,88 (USD 44.15), and that of medication errors was R$ 1.188,43 (USD 571.06). Antimicrobial electrolytes and analgesics were the main medicines involved in medication errors. As regards the causal factors of the analyzed falls, 25.7% were related to the patient category, 22.9% to the team, 17.1% to the environment, 14.3% to the task, 11.4% to the individual and 8.6% to management. A total of 83 causes contributed to medication-error occurrence, and the management category contributed with 32.6% of the errors. The individual category contributed with 21.7%, the team with 19.3%, the environment with 12.0%, task with 9.6% and patient with 4.8%. Later, recommendations to prevent the occurrence of these incidents in the institution were proposed with a focus on best practices.

A segurança do paciente e a qualidade da assistência à saúde, no uso de medicamentos, têm sido foco de preocupação e estudos em nível mundial. Os pacientes podem estar especialmente vulneráveis a danos imediatamente após alta hospitalar, e a ocorrência de eventos adversos relacionados a medicamentos pode resultar em atendimento em serviços de urgência ou em readmissão hospitalar. Este estudo teve como objetivo compreender a dinâmica e os desafios do cuidado fornecido ao paciente, pela equipe de saúde do hospital, visando à segurança no processo de uso de medicamentos após alta hospitalar. Foi realizada pesquisa exploratória por meio de entrevistas junto a médicos, enfermeiros, farmacêuticos e assistentes sociais do Hospital Universitário da Universidade de São Paulo. Atualmente, a principal estratégia adotada pelo hospital visando à segurança do paciente, com foco no processo de uso de medicamentos após alta hospitalar, é a orientação de alta ao paciente e/ou cuidador, realizada de forma estruturada, em casos selecionados, principalmente envolvendo pacientes pediátricos. A reconciliação medicamentosa está em fase de implantação na instituição e, em situações específicas, ocorre mobilização da equipe multidisciplinar para viabilização do acesso a medicamentos prescritos na alta hospitalar. Visita domiciliar é desenvolvida junto a pacientes críticos com problemas de locomoção, e não conta com a participação de farmacêuticos. As principais barreiras para implantação, desenvolvimento e ampliação dessas atividades são a falta de recursos humanos e de tecnologias da informação e a necessidade de alterações no procedimento de alta. Entre os fatores facilitadores estão características da equipe, como iniciativa, comprometimento, responsabilidade por resultados e qualificação, além do apoio da alta administração. O desenvolvimento de atividades acadêmicas junto à atenção básica facilita o estabelecimento de pontes entre o hospital e demais serviços de saúde, contribuindo para a transposição da barreira da falta de contato entre as equipes. No entanto, as limitações das atividades desenvolvidas e a falta de articulação adequada para a continuidade do cuidado, com foco no processo de uso de medicamentos, podem comprometer a segurança do paciente na interface entre hospital, atenção básica e domicílio. / Patient safety and quality of health care on medication use have been a central topic of discussion and focused in studies worldwide. Patients can be particularly vulnerable in the period immediately following their discharge from hospital and the occurrence of adverse drug events may require emergency care and hospital readmission. The present study aimed to understand the dynamics and challenges of care provided to patients by hospital providers focusing on safe use of medications after discharge. An exploratory study was conducted. Data was collected through interviews with physicians, nurses, pharmacists and social workers at the Hospital Universitário da Universidade de São Paulo, Brazil. The hospitals current main strategy for safe use of medications after hospital discharge is to provide structured counseling to selected patients and/or their caregivers especially pediatric patients. Medication reconciliation is being implemented and a multidisciplinary team can help ensure access to prescription drugs at discharge in some cases. Home visits are paid to patients with severe conditions and mobility problems but pharmacists are not involved. The main barriers to implementation, development, and expansion of these activities include limited human and information technology resources and changes required to patient discharge procedures. The main facilitators are a skilled team of care providers, committed to improving care and accountable for results and support from senior management. Care provided by students and residents at a primary care setting helps create bridges to integrate hospital care and other care services and overcome the interaction barrier between care teams. However, limited actions and inadequate coordination of follow- up care focused on medication use may compromise patient safety at the interface of hospital, primary care and the home setting.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2017-08-22T20:43:20Z No. of bitstreams: 1 Ana Paula de Andrade Silva.pdf: 1264246 bytes, checksum: f8163c20ad8d731f8e4d1bd527771a51 (MD5) / Made available in DSpace on 2017-08-22T20:43:20Z (GMT). No. of bitstreams: 1 Ana Paula de Andrade Silva.pdf: 1264246 bytes, checksum: f8163c20ad8d731f8e4d1bd527771a51 (MD5) Previous issue date: 2016 / Mestrado Profissional em Ensino na Saúde / O objeto do estudo é a educação permanente em saúde a partir de aspectos técnicos observados no preparo e administração de medicamentos intravenosos na terapia intensiva. O objetivo geral foi analisar incidentes no preparo e administração da terapia medicamentosa intravenosa, como estratégia de educação permanente. Os objetivos específicos foram descrever a prática laborativa da equipe técnica na terapia medicamentosa intravenosa no cenário do estudo; analisar as características da assistência prestada pela equipe técnica de saúde que se associam ao aparecimento dos incidentes no preparo e administração dos medicamentos no setor investigado; e propor programa na perspectiva da educação permanente em saúde baseados nos incidentes encontrados no preparo e administração dos medicamentos intravenosos. Material e Método: Pesquisa descritiva, com abordagens qualitativa e quantitativa e observação participante, tendo sido aprovada pelo Comitê de Ética em Pesquisa da UFF sob parecer nº 1.118.304. Foi desenvolvida em um Centro de Tratamento Intensivo de Adulto na Região do Médio Paraíba, no Estado do Rio de Janeiro. Os sujeitos do estudo foram os Auxiliares e Técnicos de Enfermagem que aceitaram participar e concordaram com os procedimentos éticos disciplinados pela Resolução nº 466/12. Toda a observação realizada utilizou como instrumento um roteiro sistematizado, tipo check-list. Critério de inclusão: medicações intravenosas preparadas e administradas por Auxiliares e Técnicos de Enfermagem sob prescrição médica. Critério de exclusão: medicações administradas por ordem verbal. Resultados: Foram totalizadas 169 doses. Conclusão: A frequência mostra que os ofensores incidem na técnica de assepsia, na utilização do equipamento de proteção individual, na limpeza da bancada, na identificação do medicamento, na técnica de administração do medicamento e na técnica de antissepsia para administrar o medicamento. Desta forma, a pesquisa contribui com instrumento para direcionar as condutas na fase de preparo e administração de medicamentos intravenosos / The object of study is Health permanent education based on technical aspects observed during preparation and administration of intravenous medication on intensive care unit. The main goal consisted in analyzing incidents during preparation and administration of intravenous medication, as a strategy to permanent education. The specific goals consisted in describing the work activity, on the study context, of the technical team during intravenous medication therapy; analyzing the characteristics of care provided by the technical health team which is associated to the occurrence of incidents during preparation and administration of medication on the sector under study; and proposing a program about permanent health education based on the incidents that occurred during preparation and administration of intravenous medication. Material and Method: Descriptive research, having qualitative and quantitative approaches and participant observation, which was approved by the UFF’s Ethics on Research Committee under the statement nº 1.118.304. It was developed on an Adult Intensive Care Unit in Médio Paraíba Region, in Rio de Janeiro State. The subjects of study were Nursing Assistants and Technicians who accepted to participate and agreed with the ethic procedures registered on Resolution nº 466/12. The instrument used by the observation was a systemized guide, as a check-list. Inclusion Criteria: intravenous medications prepared and administrated by nursing assistants and technicians on medical prescription. Exclusion criteria: medication administration in verbal order. Results: In total 169 shots. Conclusion: The frequency shows that the errors occur on: asepsis technique, individual protection equipment utilization, work surface cleaning, identification of the medication, and antisepsis technique to the medication administration. Therefore, the research contributes as an instrument to guide how to behave during preparation and administration of intravenous medication

A segurança do paciente e a qualidade da assistência à saúde, no uso de medicamentos, têm sido foco de preocupação e estudos em nível mundial. Os pacientes podem estar especialmente vulneráveis a danos imediatamente após alta hospitalar, e a ocorrência de eventos adversos relacionados a medicamentos pode resultar em atendimento em serviços de urgência ou em readmissão hospitalar. Este estudo teve como objetivo compreender a dinâmica e os desafios do cuidado fornecido ao paciente, pela equipe de saúde do hospital, visando à segurança no processo de uso de medicamentos após alta hospitalar. Foi realizada pesquisa exploratória por meio de entrevistas junto a médicos, enfermeiros, farmacêuticos e assistentes sociais do Hospital Universitário da Universidade de São Paulo. Atualmente, a principal estratégia adotada pelo hospital visando à segurança do paciente, com foco no processo de uso de medicamentos após alta hospitalar, é a orientação de alta ao paciente e/ou cuidador, realizada de forma estruturada, em casos selecionados, principalmente envolvendo pacientes pediátricos. A reconciliação medicamentosa está em fase de implantação na instituição e, em situações específicas, ocorre mobilização da equipe multidisciplinar para viabilização do acesso a medicamentos prescritos na alta hospitalar. Visita domiciliar é desenvolvida junto a pacientes críticos com problemas de locomoção, e não conta com a participação de farmacêuticos. As principais barreiras para implantação, desenvolvimento e ampliação dessas atividades são a falta de recursos humanos e de tecnologias da informação e a necessidade de alterações no procedimento de alta. Entre os fatores facilitadores estão características da equipe, como iniciativa, comprometimento, responsabilidade por resultados e qualificação, além do apoio da alta administração. O desenvolvimento de atividades acadêmicas junto à atenção básica facilita o estabelecimento de pontes entre o hospital e demais serviços de saúde, contribuindo para a transposição da barreira da falta de contato entre as equipes. No entanto, as limitações das atividades desenvolvidas e a falta de articulação adequada para a continuidade do cuidado, com foco no processo de uso de medicamentos, podem comprometer a segurança do paciente na interface entre hospital, atenção básica e domicílio. / Patient safety and quality of health care on medication use have been a central topic of discussion and focused in studies worldwide. Patients can be particularly vulnerable in the period immediately following their discharge from hospital and the occurrence of adverse drug events may require emergency care and hospital readmission. The present study aimed to understand the dynamics and challenges of care provided to patients by hospital providers focusing on safe use of medications after discharge. An exploratory study was conducted. Data was collected through interviews with physicians, nurses, pharmacists and social workers at the Hospital Universitário da Universidade de São Paulo, Brazil. The hospitals current main strategy for safe use of medications after hospital discharge is to provide structured counseling to selected patients and/or their caregivers especially pediatric patients. Medication reconciliation is being implemented and a multidisciplinary team can help ensure access to prescription drugs at discharge in some cases. Home visits are paid to patients with severe conditions and mobility problems but pharmacists are not involved. The main barriers to implementation, development, and expansion of these activities include limited human and information technology resources and changes required to patient discharge procedures. The main facilitators are a skilled team of care providers, committed to improving care and accountable for results and support from senior management. Care provided by students and residents at a primary care setting helps create bridges to integrate hospital care and other care services and overcome the interaction barrier between care teams. However, limited actions and inadequate coordination of follow- up care focused on medication use may compromise patient safety at the interface of hospital, primary care and the home setting.