Medical errors can be costly for both patient and hospital. As defined by the Joint Commission (www.jointcommission.org/assets/1/18/Hot_Topics_Transitions_of_Care.pdf [11]), in order to keep patients safe, clinicians should focus on the three key points along the patient’s continuum of care. To help, free resources are available.

Upon admission
Patient admission is a critical time for risk assessment. Clinicians should employ screening tools to identify high-risk patients before procedures. For patients potentially receiving opioids, this can include the Risk Index for Serious Prescription Opioid-Induced Respiratory Depression or Overdose (RIOSORD).

Patient recovery
As patients recover from procedures, it is common for patient-controlled analgesia (PCA) pumps to be employed to manage pain. The Physician-Patient Alliance for Health & Safety (PPAHS) PCA Safety Checklist is a free downloadable resource developed by a panel of experts to reduce the risk of opioid-related adverse events (www.ppahs.org/pca-safety-checklist-download [12]).

Patient discharge
Clinicians should take steps to actively engage patients and their families as partners in their health. Patients are encouraged to ask the following five questions about their medications: 
1.    Have any medications been added, stopped, or changed, and why?
2.    What medications do I need to keep taking, and why?
3.    How do I take my medication, and for how long?
4.    How will I know if my medication is working, and what side effects do I watch for?
5.    Do I need any tests and when do I book my next visit?

We encourage clinicians to download a PDF version of these five questions and share it with their patients (www.ismp-canada.org/medrec/5questions.htm [13]).

For more resources dedicated to patient safety, visit the Canadian Patient Safety Institute (CPSI) and PPAHS websites (www.cpsi.com [14], www.ppahs.org [15]).
—Stephen Routledge, MPH
Patient Safety Improvement Lead
Canadian Patient Safety Institute 
—Michael Wong, JD
Founder and Executive Director 
Physician-Patient Alliance for Health and Safety