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Maximizing the Impact of Pharmacy Services in Transitions of Care
Ashley Core, PharmD September 30, 2016
Maximizing the Impact of Pharmacy Services in Transitions of Care - - PowerPoint PPT Presentation
Maximizing the Impact of Pharmacy Services in Transitions of Care - - PowerPoint PPT Presentation
Maximizing the Impact of Pharmacy Services in Transitions of Care Ashley Core, PharmD September 30, 2016 Disclosure Statement The following individuals have nothing to disclose concerning possible financial or personal relationships with
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Objectives
Name common barriers encountered in
establishing medication reconciliation services
Describe the potential impact of pharmacy
involvement in medication reconciliation and transitions of care (Pharmacist and Technician)
Identify resources that are available to launch
- r optimize pharmacy services within the
transitions of care process
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Current State
Transitions of care1
“…the movement of
patients between health care locations, providers, or different levels of care within the same location as their conditions and care needs change.”
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Recognizing the Need
National Patient Safety Goal 03.06.012
“…document and pass along information about patients’
medications; review safe practices for medication reconciliation”
Centers for Medicare and Medicaid Services3
“…performs medication reconciliation for more than 50%
- f transitions of care”
Institute for Healthcare Improvement4
“…prevent adverse drug events (ADEs) by implementing
medication reconciliation”
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Role of the Health-System Pharmacist?
Medication history
Admission medication reconciliation
Disease specific counseling
High risk medication counseling
Medication therapy management
Bedside pharmacy services
Medication access
Discharge medication reconciliation
Discharge counseling
Post discharge phone calls
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Potential Impact
Improved patient safety
Fewer admission medication history-related errors Greater accuracy of discharge summary medication lists
Enhanced patient experience
Better understanding of discharge medications
Cost avoidance
Decreased costs/length of stay related to medication
errors
Reduced emergency department visits Reduced hospital admissions/re-admissions
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Supporting Evidence
Author Year Primary
- utcome
Intervention(s) Results
Gleason et al5 (MATCH) 2010 Medication
- rder errors on
admission
- Pharmacist-obtained
medication histories
- Admission medication
reconciliation
- 35.9% with order error on admission
- 85% of errors originated in medication
histories
- 52.4% with potential to cause harm
without intervention Anderegg et al6 2014 30 day readmission rate
- Admission and discharge
medication reconciliation
- Expanded clinical pharmacy
services, including ED
- 5.5% decrease in 30 day readmissions
in high-risk patients (p=0.042)
- Projected cost savings = $780,000
Kirkham et al7 2014 30 day readmission rate
- Bedside medication
delivery
- Follow-up phone calls
- Control group had twice the odds of
readmission within 30 days (OR, 1.9; 95% CI 1.92-19)
- Six-fold increase in 30 day readmission
in patients 65 years or older (OR, 6.05;95% CI, 1.92-19) Sanchez et al8 2015 30 day readmission
- r ED visit rate
- Pharmacist telephone
intervention
- Decreased 30 day readmission rate in
patients who received pharmacist intervention post discharge (0.277 vs. 0.519, p<0.001)
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Where to begin?!
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ASHP-APhA Best Practices9
“Partnered to assess examples of currently implemented
care models that improve patient outcomes by involving pharmacists in medication-related transitions of care…”
Reviewed “Medication Management in Care Transitions”
models from over 80 institutions
Assessment focused on 3 main criteria:
Impact of care transitions model on patient care Pharmacy involvement in the transition process from
inpatient to home settings
Potential to scale and operationalize the process for
implementation by other health systems
Eight programs distinguished as “Best Practices”
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Common Barriers
Organization Administration Medical and nursing staff Qualifications Training Coverage hours Staff Computers Office Space EHR capabilities Method for information transfer
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Key Characteristics
Started out small
Pilot programs
Launched strategic services
Medication reconciliation = key component Considered the needs of the institution Targeted specific patient population(s)
Worked within their means
Restructured current staff Utilized pharmacist-extenders Grant funding
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Key Characteristics
Regularly collected and reported data
Focused on cost-saving initiatives Medication safety Patient satisfaction scores
Looked for opportunities to collaborate
Multi-disciplinary care teams Schools of pharmacy and medicine
Innovated to expand services
Expanded roles for technicians, residents, interns Pharmacotherapy clinic Bedside prescription delivery
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Used with permission from ASHP and APhA: Appendix A. Pg 56. Key attributes of programs demonstrating best practices in medication management in care transitions; ASHP-APhA Medication Management in Care Transitions Best Practices; https://www.pharmacist.com/medication-management-care-transitions-best-practices; published February 2013; accessed July 2016.
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Used with permission from ASHP and APhA: Appendix A. Pg 56. Key attributes of programs demonstrating best practices in medication management in care transitions; ASHP-APhA Medication Management in Care Transitions Best Practices; https://www.pharmacist.com/medication-management-care-transitions-best-practices; published February 2013; accessed July 2016.
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Site Specific Considerations
Needs of the organization Current process in place Available staff to be allocated Process for educating staff Patient population to be targeted EHR capabilities Metrics
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Creating a Plan for Success
Identify the need(s) of the patients, institution, C-suite Recognize and devise a plan to
- vercome
barriers Use available resources to launch strategic service(s) Collect data to show impact to fund future service(s)
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Available Resources
ASHP-APhA Medication Management in Care
Transitions Best Practices9
MARQUIS Implementation Manual: A Guide for
Medication Reconciliation Quality Improvement10
Transitions of Care Coalition: Care Transition Bundle,
Seven Essential Intervention Categories11
Re-engineered Discharge (RED) Toolkit12 Medications at Transitions and Clinical Handoffs
(MATCH) Toolkit for Medication Reconciliation13
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References
- 1. Transitions of Care Measures, Paper by the NTOCC Measures Work Group; National Transitions of Care
Coalition; http://www.ntocc.org/Portals/0/PDF/Resources/TransitionsOfCare_Measures.pdf; published 2008; accessed August 2016.
2.
2016 Hospital National Patient Safety Goals; Joint Commission; https://www.jointcommission.org/assets/1/6/2016_NPSG_HAP_ ER.pdf ; published 2016; accessed July 2016.
- 3. Eligible Professional Meaningful Use Menu Set Measures, Measure 6 of 9; Centers for Medicare and Medicaid
Services; https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/7 _Medication_ Reconciliation.pdf; updated 2014; accessed July 2016.
- 4. Protecting 5 Million Lives from Harm, Overview; Institute for Healthcare Improvement;
http://www.ihi.org/Engage/Initiatives/Completed/5MillionLivesCampaign/Pages/default.aspx; accessed August 2016.
- 5. Gleason KM, McDaniel MR, Feinglass J, et al. Results of the medications at transitions and clinical handoffs
(MATCH) study: an analysis of medication reconciliation errors and risk factors at hospital admission. J Gen Intern Med. 2010; 25(5):441-7.
- 6. Anderegg SV, Wilkinson ST, Couldry RJ, Grauer DW, Howser E. Effects of a hospitalwide pharmacy practice
model change on readmission and return to emergency department rates. Am J Health-Syst Pharm. 2014;71:1469-79.
- 7. Kirkham HS, Clark BL, Paynter J, Lewis GH, Duncan I. The effect of a collaborative pharmacist-hospital care
transition program on the likelihood of 30-day readmission. Am J Health-Syst Pharm. 2014; 71:739-45.
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References
8.
Sanchez GM, Douglass MA, Mancuso MA. Revisiting project re-engineered discharge (RED): the impact of a pharmacist telephone intervention on hospital readmission rates. Pharmacotherapy. 2015;35(9):805-12
9.
Cassano A; ASHP-APhA Medication Management in Care Transitions Best Practices; American Pharmacists Association; https://www.pharmacist.com/medication-management-care-transitions-best- practices; published February 2013; accessed July 2016.
10.
MARQUIS Investigators; MARQUIS Implementation Manual A Guide for Medication Reconciliation Quality Improvement; Society of Hospital Medicine; https://www.hospitalmedicine.org/Web/Quality___ Innovation/Implementation_Toolkit/MARQUIS/Download_Manua_Medication_Reconciliation.aspx; published October 2014; accessed August 2016.
11.
NTOCC Seven Critical Interventions; National Transitions of Care Coalition Knowledge and Resource Center; http://www.ntocc.org/AboutUs/KnowledgeResourceCenter/tabid/144/Default.aspx; accessed August 2016.
12.
Jack B, Paasche-Orlow M, Mitchell S, Forsythe S, Martin J, Brach C. Re-Engineered Discharge (RED) Toolkit; Agency for Healthcare Research and Quality; http://www.ahrq.gov/professionals/systems/hospital/red/toolkit/ index.html ;updated April 2016; accessed August 2016.
13.
Gleason K, Brake H. Medications at transitions and clinical handoffs (MATCH) toolkit for medication reconciliation; Agency for Healthcare Research and Quality; http://www.ahrq.gov/sites/default/files/publications/files/match.pdf; updated August 2012; accessed August 2016.
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Assessment
All of the following are common barriers
encountered during implementation and/or expansion of pharmacy services within a transitions of care program, EXCEPT:
- a. Buy in from hospital leadership
- b. Financial resources
- c. Excess available staff
- d. Method for timely and consistent communication