Definition of “next provider of service”
Q. How do you define and identify the “next provider of service?”
A. For purposes of this safety goal, the “next provider of service” is that individual (or individuals) with whom the patient has an established relationship for receiving health care services or, if there is not yet an established relationship, has accepted a scheduled appointment for follow-up care. In all other cases, this information should be forwarded to a practitioner only if the patient/client/resident consents to this communication of his/her personal health information.
Q. At discharge or transfer, do we reconcile against the patient’s current (inpatient) medication list or the home medication list?
A. At discharge, a complete list of the medications that the patient/client/resident is to be taking following discharge should be developed and reconciled against both the current inpatient list and the home medication list. The discharge medication list should include not only the medications that are prescribed at the time of discharge, but any other medications the patient/client/resident will be taking, including over-the-counter meds, vitamins, etc. The purpose of this discharge reconciliation is to provide the patient with a single, clear list of all the medications that the patient is to be taking following discharge. This requires that all medications are identified, including any medications the patient/client/resident might have been taking at home that were discontinued or “held” during the episode of care. It should also determine whether any of the previous home medications should be discontinued. It is also reasonable to interview the patient to determine if he or she plans to resume taking any OTC or herbal medication after discharge. The complete, reconciled discharge medication list should then be used as a basis for the required patient/client/resident education on the safe and effective use of those medications.
Electronic availability of discharge list
Q. If the discharge medication list is available electronically to all members of our medical staff, such as in an electronic medical record (EMR) or other electronic database, will that meet this requirement? We would fax the list only to non-staff members.
A. Yes; if the medical staff member who is the “next provider of service” knows the information exists and is available in the EMR when needed.
Receipt of list by attending physician
Q. If the same attending physician is caring for the patient in the hospital and for the follow-up care, must a discharge list be forwarded to the physician’s office?
A. Yes, the intent is for the “next provider(s) of service” to have the discharge list of medications. It is the organization’s obligation to ensure reliable access to the information in this situation.
Release of information
Q. May a patient refuse authorization to send the reconciliation list to the next provider of care if that next provider is not part of the treating organization?
A. Yes; the patient/client/resident can refuse to allow the information to be sent to any practitioner. However, if the patient/client/resident refuses to allow the information to be communicated, the organization has a responsibility to inform the patient/client/resident of the reason for wanting to send the information and the potential risks of not sharing that information with the next provider of care.
Time frame for communication of list
Q. How soon must the discharge list be communicated to the next provider of care?
A. The discharge medication list must be communicated to the next provider of care in a time frame that is consistent with the anticipated follow-up activities.