At CGH Medical Center in Sterling, Illinois, preventable readmissions represent a huge financial and clinical uncertainty.
The hospital knew that not taking medications as prescribed following discharge is one of the major drivers of readmissions, so it knew it needed a way to proactively manage this risk and improve its overall patient care. But the hospital did not have a way to monitor and intervene on these patients’ behalf, or consistently track and report on these patients.
So the hospital contracted with PipelineRx to use the health IT vendor’s Patient Discharge Solution, which provides a workflow to help pharmacists engage with patients at and following discharge. Based on their clinical skillset and deep understanding of comprehensive medication management, pharmacists are the ideal providers to counsel patients on their medications before they leave the hospital.
“This solution allows pharmacists to selectively enroll high-risk patients, then prepare for and provide counseling to those patients and their caregivers on their medications prior to discharge,” explained Chris Flemming, assistant director of pharmacy at CGH Medical Center.
“Through detailed chart reviews, the pharmacist essentially reconciles the patient’s medication regimen by comparing the medications the patient was taking before they were admitted with those ordered at the hospital and what they were prescribed at discharge,” he said.
The pharmacist documents any duplication of therapy, recommended dose changes, or other interventions for the provider to review. Once the medication regimen is finalized, the pharmacist uses the system to generate a streamlined “Med Card” that lists all current patient medication information in a user-friendly format.
“The workflow also includes reminders for pharmacists to follow up with patients after they’ve transitioned to a long-term care facility or returned home to ensure they are taking their medications correctly and to address any side effects or other medication-related questions,” Flemming said.
There is a variety of medication management systems on the health IT market today. Some of the vendors of these systems include BD, Cureatr, DrFirst, LogicStream Health, Medisafe, Mediware Information Systems and Talyst.
MEETING THE CHALLENGE
CGH Medical Center worked with PipelineRx to customize the pharmacy workflow based on the healthcare facility’s preferences, then assigned its pharmacists and pharmacy interns to manage this program during their rotation.
“For each patient, the workflow could easily be customized further, by selecting or deselecting activities,” Flemming explained. “We use the LACE score to identify high-risk patients that we wanted to enroll which is captured in the system. Whenever the pharmacist logs in, they would see all the patients that were enrolled and what the next steps were, receiving reminders when an activity was due.”
Integration with the organization’s Cerner EHR system enabled pharmacists to generate and print the “Med Card,” which Flemming reports patients love.
Flemming offers some comments from CGH Medical Center pharmacists and pharmacy interns gathered to date:
- “Following a patient’s care is a big part of what we do. This solution gives us a way to easily follow patients and keep up with their care versus writing everything on paper that could get lost forever. My favorite part of this solution is the Med Card feature. Patients gave me a lot of positive feedback on it saying it’s a great way to keep track of their medications.”
- “I love that it’s much easier to follow a patient, especially if they get readmitted.”
- “I think it’s better for the patient as well because in the past I would’ve probably thrown the handwritten information in the trash.”
- “The Med Card is much easier and it cut my time down to 15 minutes. No more having to retype things at the end of sentences or removing redundant drug information.”
- “I feel like using the software has increased my clinical knowledge.”
Pharmacists counseled more than 650 patients in the first eight months of the program at the 97-bed facility. They identified medication interventions in nearly half of all discharges. Depending on the intervention made, these changes had a major impact on patient safety and the cost of their medications.
“While we haven’t been able to measure it yet, we are looking into how this program will impact our overall readmission rates and penalties, as well as HCAHPS scores,” said Tim Dunphy, director of pharmacy at CGH Medical Center. “Anecdotally, we have already received very positive feedback from our patients and staff.”
The workflow is both intuitive and customizable for the organization, and ensures that all steps are documented in the system, even providing reminders for the pharmacists, Dunphy added.
“Further, our patients and their caregivers leave the hospital better informed about their new medication regimen,” he said. “They love the user-friendly Med Card and appreciate the follow-up call to address any side effects or dosing questions.”
ADVICE FOR OTHERS
Hospitals across the country are trying to mitigate the risk that unpredictable readmissions represent, and there’s no doubt the cause is complex and multifaceted depending on each individual patient’s case, said Dunphy.
“We’ve found that by tackling just this one part of the process – medication management – we can help our patients feel more confident in managing their own care when they leave the hospital,” he advised. “My main advice would be to get started now because the impact could be immediate and significant in reducing readmissions and associated penalties, as well as HCAHPS scores, and more importantly, patient outcomes.”
From a logistical perspective, CGH Medical Center knew it could not launch a program like this with existing staff.
“I would encourage other facilities to take an honest look at existing resources and evaluate if programs like this are feasible,” Dunphy suggested.
“If not, working with a partner that can provide not just the platform but also the clinical resources you need can be invaluable,” he said. “By breaking this problem down into various intervention points – such as at the patient bedside right before they leave – we’re beginning to understand how to proactively reduce medication errors outside the hospital.”
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