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Gina Bencivenga Andrew, PharmD
“Meds to Bed” Implementing a Bedside Discharge Pharmacy Service within an Academic, Acute Care, Medical Center Gina Bencivenga Andrew, PharmD Melissa Agonia, PharmD Ashley Warnock, CPhT
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Objectives: Pharmacists
Identify two barriers in achieving optimal outcomes for patients discharged from the hospital requiring new medication therapy management. Identify two focuses in achieving overall patient satisfaction scores in medication management at the time of discharge. Describe the impact of decentralized pharmacists participating in Collaborative Care Rounds in partnership with Lifespan Pharmacy to provide safe transitions of care and thereby reducing readmissions.
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Objectives: Pharmacy Technicians
Describe the impact a pharmacy technician can make in achieving prescription capture. Describe how a pharmacy technician can assist in achieving overall patient satisfaction scores in medication management at the time of discharge.
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Lifespan Pharmacy Locations Services Rhode Island Hospital (May 2013)
Retail Specialty The Miriam Hospital (October 2014) Services Rhodes Island Hospital The Miriam Hospital Bradley Hospital Newport Hospital Lifespan Affiliates
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Lifespan Pharmacy Integrated: full access to patient’s hospital record including inpatient medications, lab and microbiology results, physician notes and pharmacy interventions Collaborative: consult with the patient’s physicians, nurses, inpatient pharmacists, and other health professionals before the patient even leaves the hospital Patient centered: deliver the medications right to the patient’s bedside before they are discharged
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Goals of Lifespan Pharmacy
Provide patients with integrated and coordinated care that is of the highest level of quality, safety, and satisfaction. Facilitate collaboration with all healthcare professionals and foster safe transitions in care. Provide a patient centered, continuum of care relating to medications.
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Problem
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Problem Chronic diseases affect 45% of the population, account for 81% of all hospital admissions, 91% of all prescriptions filled1 Overall, nearly 75% of adults do not follow their doctor’s orders when it comes to taking prescribed medication (i.e., non-adherent: not filling new prescription, taking less than the recommended dose, or stopping the medicine).2 1Partnership to Fight Chronic Disease. The Growing Crisis of Chronic Disease in the United States 2007. 2Improving Prescription Medicine Adherence is Key to Better Health Care. PhRMA, January 2011.
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Problem Medication non-adherence is associated with1:
5.4 times increased risk of hospitalization, re-hospitalization, or premature death for patients with high blood pressure 2.5 times increased risk of hospitalization for patients with diabetes Economic burden of $100 billion -$300 billion per year Approximately 50% of medication errors occur at times of transitions in care (i.e., admission, transfer, discharge) 1Improving Prescription Medicine Adherence is Key to Better Health Care. PhRMA, January 2011.
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Discharge Prescription Barriers
Consultation; medication teach & information Transportation Insurance denial High co-pay Logistics Pharmacy State Law Prescription clarity ePrescribing – transmission & receiving
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Patients
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Challenge Capturing prescriptions from inpatient population
Prescriber Patient – comfort & familiarity with local pharmacy Communication Prescriber & Patient Awareness of services provided & benefit Prescriber & Pharmacy Flag for discharge Releasing prescription to pharmacy Timeliness of Delivery Patient consultation Safe storage of medication Turn-around time
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Maria Ducharme MS RN NEA-BC Gina Bencivenga Andrew PharmD
OpX Optimization Project Utilization of Lifespan Pharmacy for Patient Discharge Maria Ducharme MS RN NEA-BC Executive Sponsor Gina Bencivenga Andrew PharmD Project Owner Jorge Pereira OpX Training Specialist OpX Members: Melissa Agonia, PharmD Kellie Armstrong, RN MS CBN Christine Dyer, RPh Chris Tucci, MS RN BC CURN Ashley Warnock, CPhT Leigh Hubbard, BSN RN ONC Christine Beyer, MD Susan Cooney, BSN RN Lisa Poncin, RN Danielle Fagan, MSW LICSW Jennifer Pickering, RN
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Patient Benefits Bedside delivery to inpatients
Free home delivery for refills Convenience and patient satisfaction Continuum of Care beyond inpatient discharge or outpatient visit Transitions of Care coordination: MD confidence that Prescriptions will be filled Insurance issues resolved (PA’s, non-formulary, etc.) Discuss medication cost issues Reduce non-adherence and readmissions
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Role of the TOC Pharmacist
Prevent Adverse Drug Events (ADEs) upon discharge Identify medication related problems that can lead to hospital re-admissions Minimize potential barriers that may exist within access to medication Provide medication education and teaching Collaborate across all areas of healthcare internal and/or external providers where appropriate Close “gaps” that occur during transitions of care Hospital to home (most of our cases)
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Patient Experience LifeChart – electronic medical record
Flag for discharge Technician will go to patient chart Ask patient if they want the Rx filled at LP Process & fill at Lifespan Pharmacy Prescriptions brought to patient bedside Offer to counsel – technician/pharmacist teach Answer any questions patient may have re: treatment and provide a med reconciliation with patient and/or family. Able to pay at bedside
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Program
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Bariatric Surgical Patients
Collaboration between Bariatric Surgery and Lifespan Pharmacy. Kellie Armstrong - MBS Coordinator Melissa Agonia – Pharmacist in Charge Pre-surgical visit Bedside delivery and counseling Follow up
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Providers
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Provider Collaboration
Physician/LIP consultation with pharmacist prior to patient discharge Collaboration on access to treatment issues for individual patients and specific patient populations Vested interest in patient outcomes (e.g., medication adherence, side effect management, readmission prevention, specialty drug monitoring)
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Comprehensive Health Care
Patient – 32 y/o male, hx cystic fibrosis, s/p lung transplant x 3, admitted for CAP, discharge tx for nebulized Tobramycin. Nursing – Shaina Gardner Case Manager – Beth Lapointe Pharmacy – Adam Lang, Melissa Agonia, Ashley Warnock, Amy Phelps ___________________________________________________ Specialty Service Lines – Bariatric/Joint/Oncology/Urology Provider/Prescriber/Social Work/Respiratory
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Purpose
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Financial Performance
Non-specialty medications – low margins Specialty medications – stronger margins Some critical medications have negative margins but strong return on overall patient outcomes (e.g., enoxaparin)
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Specialty & High Cost Medications
Specialty & High Cost Medications Transitions of Care -> End Goal ->Reducing Readmission Rates Diabetes Lantus Insulin Respiratory Advair Spiriva Combivent Respimat Anticoagulants & Platelet Inhibitors Brilinta Effient Eliquis Fondaparinux Lovenox Pradaxa Xarelto Antibiotics Tobramycin (Nebulizer) Voriconazole Vancocin Xifaxan Zyvox
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Performance
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Measure of Success Currently providing “Meds to Bed” to 30% of the total discharged patients. December 2015 goal is to reach 50% capture rate of the discharged patients. Skilled Nursing Facility Rehabilitation Long term care / Assisted Living Insurance Limitations
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Measure of Success Press Ganey & HCAHPS Decrease overall readmissions
Patient satisfaction & experience Did you receive information about your medication prior to discharge? Where you informed why your new medication was prescribed? Did you understand the purpose of the medication prescribed? Where the potential side effects of the new medication explained to you?
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Discussion
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