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Valuable Information Often Omitted During Transitions

      Doug Brunk is with the San Diego bureau of Elsevier Global Medical News.
      LONG BEACH, CALIF. – If you can get hospitalized elderly patients close to their pre-illness health and functional status before you send them to the next care setting, “you are doing well,” Dr. Moira Fordyce said at the annual meeting of the California Association of Long Term Care Medicine.
      The problem is, information about a patient's baseline status may be lacking when he or she is admitted to the hospital or skilled nursing facility. As a result, clinicians “might aim for what is no longer possible and in the process damage the patient,” said Dr. Fordyce, a geriatrician who has practiced in long-term care for more than 20 years.
      Other information that may be lacking during transitions of care includes:
      ▸ A detailed problem list.
      ▸ Reasons for the transfer.
      ▸ A list of every medication they're taking, including prescriptions, over-the-counter drugs, and herbal and alternative therapies. Sometimes when frail elderly patients “are admitted to the hospital, they end up being poisoned by being given regular doses of medications which they were taking only sporadically at home,” Dr. Fordyce said. “Also, elderly patients may get toxic on normal doses of many medications and get optimal results from smaller, less frequent doses.”
      ▸ A list of allergies the patient may have. “What allergies does the patient have to medication?” asked Dr. Fordyce, who is vice chair of the California Coalition for Caregivers Executive Committee. “Is it an allergy or is it a side effect?” It is important to know the difference in case the medication is the only effective one for a given issue. “Many side effects can be managed, but allergy is a different matter.”
      ▸ Information about the caregivers. Who are they? Is there a key person? How can you get in contact with them?
      ▸ A contact phone number for the patient's family.
      ▸ Information about advance directives.
      Dr. Fordyce said poor care transitions can result in increased morbidity, mortality, readmissions to the hospital, visits to the emergency department, and unnecessary insertion of feeding tubes. But good teamwork can help improve transitions.

      Universal Transfer Form

      AMDA recommends its Universal Transfer Form (UTF) to facilitate the transfer of necessary patient information between care settings.
      Patient transfers are fraught with the potential for errors stemming from inaccurate or incomplete transfer of patient information. The UTF can help to minimize such errors by ensuring that information is transmitted fully and in a timely fashion.