International Journal of Clinical Pharmacy

, Volume 40, Issue 6, pp 1614–1620 | Cite as

Medication-related problems during transfer from hospital to home care: baseline data from Switzerland

  • Carla Meyer-MassettiEmail author
  • Vera Hofstetter
  • Barbara Hedinger-Grogg
  • Christoph R. Meier
  • B. Joseph Guglielmo
Research Article


Background The shift from inpatient to ambulatory care has resulted in an increase in home care patients. Little is known regarding medication safety associated with patient transfer from hospital to home care. Objective To evaluate medication-related problems in patients transferring from hospital to home care in Switzerland. Setting A non-for-profit home care organization in the city of Lucerne/Switzerland. Methods We conducted a prospective observational study, including patients aged ≥ 64 years and receiving ≥ 4 medications at hospital discharge. Two structured questionnaires assessing the transfer process were completed by home care nurses. Prescription quality was assessed using a PCNE Type 2b Medication Review. Main outcome measures The quality of the transfer process was measured comparing agreed-upon with reported parameters. Prescription quality was analyzed assessing the unambiguity of the prescription. Potentially inappropriate medications (Priscus® list), contraindications, duplications and interactions, and clinical pharmacist-identified potential medication-related problems were collected. Results Study patients (n = 100) received 8.6 ± 3.5 regularly administered medications. Only 5/100 patients had a complete set of written discharge information. At the time of the first visit, 13/100 patients had no written medication information available. Discharge medication prescriptions were clear to nurses in 62% of patients. In 20 patients, the required medications were unavailable, resulting in 19 medication errors. Assessment by a clinical pharmacist revealed only 33/100 patients had a clear discharge prescription. Of a total of 984 prescribed drugs, 16% were considered to be ambiguous, 22 (2.2%) were potentially inappropriate. 7/984 drugs were contraindicated, 8 were duplicates. Conclusion In addition to the known risk factors in patients transferring from hospital to home care (age, polymedication, multiple providers), 3 major problems impacted upon medication safety: fragmented communication, unreliable medication availability and a poor prescription quality. Clinical pharmacists are an important option to improve medication safety ass.


Home care Hospital discharge Medication safety Seamless care Switzerland Transition of care 



The authors would like to thank the team of Spitex Stadt Luzern, specifically Tamara Renner, director, for enabling this study. We would also like to acknowledge Prof. Kurt Hersberger and Dr. Fabienne Böni, Pharmaceutical Care Research Group, University of Basel, Basel, Switzerland for their guidance compiling the documents for approval by the Ethics Committee.


Part of this work was funded by the non-for-profit Home Care Organization Spitex Stadt Luzern/Switzerland, the Spitex Association of the Canton of Lucerne/Switzerland, the Department of Health of the Canton of Lucerne/Switzerland, and the LOA IV foundation of the Swiss Society of Pharmacists and the Swiss health insurance companies.

Conflicts of interest

The authors declare that they have no conflicts of interest.


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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Clincal Pharmacy & Epidemiology, Department of Pharmaceutical SciencesUniversity of BaselBaselSwitzerland
  2. 2.Hospital Pharmacy, University Hospital of BaselBaselSwitzerland
  3. 3.Spitex Stadt LuzernLucerneSwitzerland
  4. 4.School of PharmacyUniversity of California San FranciscoSan FranciscoUSA

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