“Meds to Bed”Implementing a Bedside Discharge

Pharmacy Service within an Academic, Acute Care, Medical

CenterGina Bencivenga Andrew, PharmD

Melissa Agonia, PharmDAshley Warnock, CPhT

1

1. Identify two barriers in achieving optimal outcomes for patients discharged from the hospital requiring new medication therapy management.

2. Identify two focuses in achieving overall patient satisfaction scores in medication management at the time of discharge.

3. 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.

2

Objectives: Pharmacists

1. Describe the impact a pharmacy technician can make in achieving prescription capture.

2. Describe how a pharmacy technician can assist in achieving overall patient satisfaction scores in medication management at the time of discharge.

3

Objectives: Pharmacy Technicians

Locations Rhode Island Hospital (May 2013)

Retail Specialty

The Miriam Hospital (October 2014) Retail

ServicesRhodes Island HospitalThe Miriam HospitalBradley HospitalNewport HospitalLifespan Affiliates

4

Lifespan Pharmacy

5

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

6

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.

Problem

7

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

8

Problem

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.

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)

9

Problem

1Improving Prescription Medicine Adherence is Key to Better Health Care. PhRMA, January 2011.

Consultation; medication teach & information

TransportationInsurance denialHigh co-payLogistics

Pharmacy State Law Prescription clarity ePrescribing – transmission & receiving

10

Discharge Prescription Barriers

Patients

11

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

12

Challenge

Maria Ducharme MS RN NEA-BCExecutive Sponsor

Gina Bencivenga Andrew PharmDProject OwnerJorge Pereira

OpX Training Specialist

13

OpX Optimization ProjectUtilization of Lifespan Pharmacy for Patient

Discharge

Patient Benefits

Bedside delivery to inpatientsFree home delivery for refillsConvenience and patient satisfactionContinuum of Care beyond inpatient discharge or

outpatient visitTransitions 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

14

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)

15

LifeChart – electronic medical record Flag for dischargeTechnician will go to patient chart

Ask patient if they want the Rx filled at LPProcess & fill at Lifespan PharmacyPrescriptions 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

16

Patient Experience

Program

17

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

18

Bariatric Surgical Patients

19

Providers

20

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)

21

Provider Collaboration

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

22

Comprehensive Health Care

Purpose

23

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)

24

Financial Performance

25

Specialty & High Cost Medications

Transitions of Care -> End Goal ->Reducing Readmission Rates

• Anticoagulants & Platelet Inhibitors• Brilinta• Effient• Eliquis• Fondaparinux• Lovenox• Pradaxa• Xarelto

• Antibiotics• Tobramycin (Nebulizer)• Voriconazole• Vancocin• Xifaxan• Zyvox

• Diabetes

• Lantus Insulin

• Respiratory

• Advair• Spiriva• Combivent Respimat

Performance

26

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

27

Measure of Success

Press Ganey & HCAHPSDecrease overall readmissionsPatient 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?

28

Measure of Success

Discussion

29