The Impact of Clinical Pharmacists Role in Transition of Care From Other Departments to Critical Care Units in Alexandria Main University Hospital.

Transition of care between hospital departments is an important step in patient care. Every patient may need to be transmitted either for case deterioration, improvement or interventions purposes. It includes patient transition from home to hospital, transition from one hospital to another, transition from one department to another in the same hospital, transition from hospital to home. This step has many patient safety risks due to health care teams' miscommunications, shifts handoffs and use of hard copies patients' profiles crowded with papers. So many pharmaceutical and health care organizations mentioned transition of care as one of patient and organizational related quality standards . All health care team members, including clinical pharmacists, have important roles to be played. Clinical pharmacists' services differ according to the setting at which patients are presented in.

They include medication reconciliation, resolution of medications discrepancies and medication related problems, interprofessional collaboration and communication, recommendations to patients and care givers and their engagement in the therapeutic plan and post discharge follow up .

ACCP structured task force recommendations for quality measures and associated metrics according to Avedis Donabedian's model of health care quality. Process metrics involve measuring the proportion of patients receiving transition of care services and calculating the total number of medication discrepancies and medication therapy problems and their distribution, overall and by type. Outcome measures include rates of unplanned 30 days, all cause hospital readmissions, total hospital length of stay, completion rates of first planned follow-up contact within prespecified time intervals as completion of post discharge telephone interview within 72 hours and completion rates of pharmacist-referred visits for preventive medicine or other medication-related concerns.

In this study ,the investigators will focus on clinical pharmacist services within transition in the same hospital from other department to critical care units. the investigatorswill select to measure the most important and applicable outcomes regarding this step of transition.