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Transition of Care Pharmacy Project (ToCPP)

Transition of Care

Transitions of care are the various points where a patient moves to or returns from a physical location or makes contact with a health professional for the purpose of receiving care.[1] An example of a transition of care is when a patient is discharged from a hospital facility to return to the services delivered by their primary healthcare providers.

Transitions between hospital and primary healthcare settings are associated with an increased risk to patient safety.[2] Changes to medication during a hospital admission are common and it is estimated that over 90% of patients have at least one medication-related problem upon discharge.[3] Such problems include:

  • Inaccurate or incomplete transfer of medicines information
  • Missing therapy
  • Inappropriate medicines
  • Inappropriate dose
  • Adverse effects

Medication-related problems may lead to patient harm or readmission to hospital. Improving communication and patient handover across healthcare settings may prevent many of these problems.


Transition of Care Pharmacy Project

The Transition of Care Pharmacy Project (ToCPP) is being piloted in selected patient services at three hospital facilities:

  • Royal Brisbane and Women’s Hospital
  • Princess Alexandra Hospital
  • Townsville University Hospital

The project will run from March 2021 until December 2023.

Project interventions include:

  • Increased communication of medicine-related information to the patient’s nominated general practitioner and community pharmacy.
  • Post-discharge telehealth/telephone review of patients by the hospital pharmacist.


  • [1] World Health Organisation. Medication Safety in Transitions of Care Geneva: World Health Organization; 2019 (WHO/UHC/SDS/2019.9). Licence: CC BY-NC-SA 3.0 IGO; 2019 [cited 2021 Jul 07]. Available from: https://www.who.int/patientsafety/medication-safety/TransitionOfCare.pdf?ua=1.

    [2] Roughead EE, Semple SJ, Rosenfeld E. The extent of medication errors and adverse drug reactions throughout the patient journey in acute care in Australia. Int J Evid Based Healthc. 2016;14(3):113-22.

    [3] Pharmaceutical Society of Australia. Medicine Safety: Take Care. Canberra: PSA; 2019 [cited 2021 Jun 09]. Available from: https://www.psa.org.au/wp-content/uploads/2019/01/PSA-Medicine-Safety-Report.pdf

Last updated: 16 March 2022

Allied Health Professions' Office of Queensland

Phone: +61 7 3328 9298
Email: tocpp@health.qld.gov.au


Additional information

ToCPP Glossary