Industrial Pharmacists Forum

Transfer of Care

Taking a medicine is the most frequent intervention that patients will use to improve their health. In particular, older people and those with long term conditions rely heavily on medicines as a way of managing their illnesses. These patients, often taking multiple and complex regimens are some of the most vulnerable to problems with their medicines when they transfer care settings. Whether it's from care homes or primary care to hospitals, or mental health hospitals to the community, or from hospitals back to primary care, these are times when the risk of things going wrong tends to increase.

Research has consistently shown that there is a significant risk that patients' medicines will be unintentionally altered when they move care settings. A recent study found that when patients are admitted to hospital most are likely to have at least one omitted medicine or wrong dose.

It is the responsibility of all the professionals involved in the care of a patient to ensure the safe transfer of information about their medicines. To be effective, this can only be done both with the patient's needs firmly at the centre of our intentions and through professionalism and collaboration across professions.

The RPS guidance for professionals, organisations and also the patient information leaflet can all be found at

Since September 2011, the RPS have been running an early adopter site programme where a number of organisations have taken the guidance and implemented it in practice.  We will be producing a report to share the learnings from these sites on 17 June 2012 at our Medicines Safety Event. Some of the issues and learnings from these sites can be found in the discussion pages of this group.

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