Role of clinical pharmacists and pharmacy support personnel in transitions of care

Patients moving between health care settings or providers are at increased risk of complications, including unplanned hospital readmissions and medication errors. Several actions must occur in concert with members of the health care team and across settings to ensure coordinated and continuous care for patients undergoing these transitions of care (TOC). Clinical pharmacists support patients during care transitions by providing interventions and services designed to improve medication outcomes. Clinical pharmacists and team members who support clinical pharmacist activities (eg, pharmacy students, technicians, and residents) are located throughout the care continuum, from acute care to care in the community, with each contributing to improved TOC outcomes. This article provides information on evidence of high-impact clinical pharmacist TOC practices to serve as a practical guide for practitioners interested in starting or improving TOC activities. This article also addresses current and emerging best practices and offers suggestions for improving clinical pharmacist involvement in care transition activities.