Impact of a transition-of-care pharmacist during hospital discharge

Lauren Balling, Brian L Erstad, Kurt Weibel

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objective: To assess the impact of a transition-of-care pharmacist during hospital discharge. Setting: An academic medical center in southern Arizona. Practice description: One pharmacist coordinated patient discharges in two inpatient units from August 2012 through July 2013. The pharmacist attended interdisciplinary discharge coordination meetings, ensured appropriate discharge orders, facilitated the filling of medications, and educated patients on discharge medications. Practice innovation: The implementation of a transition-of-care pharmacist to provide discharge medication reconciliation and education. Main outcome measures: Readmission rates and medication interventions made by the pharmacist at discharge. Results: The pharmacist was involved in the education of 1,011 patients and performed 452 interventions. There were more readmissions per month in the control year versus the year of pharmacist involvement (median 27.5 vs. 25, P = 0.0369). Interventions made by the pharmacist to improve discharge management included starting an omitted medication (23.5%), preventing multiple discharge problems (16.4%), avoiding duplication of therapy (15.7%), correcting insurance issues related to medication coverage (12.2%), changing an improper medication dose or quantity (11.3%), changing an inappropriate prescription for a medication (5.1%), preventing a drug interaction (3.3%), and resolving other problems (12.6%). The most common medication classes involved were antimicrobial agents (9.1%), anticoagulants (8%), antihyperglycemic agents (3.8%), other drug classes (24%), and multiple drug classes (35%). Conclusion: A transition-of-care pharmacist is in a unique position to educate patients on hospital discharge, to intercept a substantial number of medication errors, and to resolve insurance issues that may lead to adherence problems. These improvements in care may result in reduced hospital readmission rates.

Original languageEnglish (US)
Pages (from-to)443-448
Number of pages6
JournalJournal of the American Pharmacists Association
Volume55
Issue number4
DOIs
StatePublished - Jul 1 2015

Fingerprint

Patient Transfer
Pharmacists
Insurance
Education
Drug interactions
Anti-Infective Agents
Hypoglycemic Agents
Pharmaceutical Preparations
Anticoagulants
Patient Discharge
Innovation
Medication Reconciliation
Inappropriate Prescribing
Patient Readmission
Medication Errors
Drug Interactions
Inpatients
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Pharmacy
  • Pharmacology
  • Pharmacology (nursing)

Cite this

Impact of a transition-of-care pharmacist during hospital discharge. / Balling, Lauren; Erstad, Brian L; Weibel, Kurt.

In: Journal of the American Pharmacists Association, Vol. 55, No. 4, 01.07.2015, p. 443-448.

Research output: Contribution to journalArticle

@article{c95674a5816342f1b6a67f4fc65dc974,
title = "Impact of a transition-of-care pharmacist during hospital discharge",
abstract = "Objective: To assess the impact of a transition-of-care pharmacist during hospital discharge. Setting: An academic medical center in southern Arizona. Practice description: One pharmacist coordinated patient discharges in two inpatient units from August 2012 through July 2013. The pharmacist attended interdisciplinary discharge coordination meetings, ensured appropriate discharge orders, facilitated the filling of medications, and educated patients on discharge medications. Practice innovation: The implementation of a transition-of-care pharmacist to provide discharge medication reconciliation and education. Main outcome measures: Readmission rates and medication interventions made by the pharmacist at discharge. Results: The pharmacist was involved in the education of 1,011 patients and performed 452 interventions. There were more readmissions per month in the control year versus the year of pharmacist involvement (median 27.5 vs. 25, P = 0.0369). Interventions made by the pharmacist to improve discharge management included starting an omitted medication (23.5{\%}), preventing multiple discharge problems (16.4{\%}), avoiding duplication of therapy (15.7{\%}), correcting insurance issues related to medication coverage (12.2{\%}), changing an improper medication dose or quantity (11.3{\%}), changing an inappropriate prescription for a medication (5.1{\%}), preventing a drug interaction (3.3{\%}), and resolving other problems (12.6{\%}). The most common medication classes involved were antimicrobial agents (9.1{\%}), anticoagulants (8{\%}), antihyperglycemic agents (3.8{\%}), other drug classes (24{\%}), and multiple drug classes (35{\%}). Conclusion: A transition-of-care pharmacist is in a unique position to educate patients on hospital discharge, to intercept a substantial number of medication errors, and to resolve insurance issues that may lead to adherence problems. These improvements in care may result in reduced hospital readmission rates.",
author = "Lauren Balling and Erstad, {Brian L} and Kurt Weibel",
year = "2015",
month = "7",
day = "1",
doi = "10.1331/JAPhA.2015.14087",
language = "English (US)",
volume = "55",
pages = "443--448",
journal = "Journal of the American Pharmacists Association : JAPhA",
issn = "1544-3191",
publisher = "American Pharmacists Association",
number = "4",

}

TY - JOUR

T1 - Impact of a transition-of-care pharmacist during hospital discharge

AU - Balling, Lauren

AU - Erstad, Brian L

AU - Weibel, Kurt

PY - 2015/7/1

Y1 - 2015/7/1

N2 - Objective: To assess the impact of a transition-of-care pharmacist during hospital discharge. Setting: An academic medical center in southern Arizona. Practice description: One pharmacist coordinated patient discharges in two inpatient units from August 2012 through July 2013. The pharmacist attended interdisciplinary discharge coordination meetings, ensured appropriate discharge orders, facilitated the filling of medications, and educated patients on discharge medications. Practice innovation: The implementation of a transition-of-care pharmacist to provide discharge medication reconciliation and education. Main outcome measures: Readmission rates and medication interventions made by the pharmacist at discharge. Results: The pharmacist was involved in the education of 1,011 patients and performed 452 interventions. There were more readmissions per month in the control year versus the year of pharmacist involvement (median 27.5 vs. 25, P = 0.0369). Interventions made by the pharmacist to improve discharge management included starting an omitted medication (23.5%), preventing multiple discharge problems (16.4%), avoiding duplication of therapy (15.7%), correcting insurance issues related to medication coverage (12.2%), changing an improper medication dose or quantity (11.3%), changing an inappropriate prescription for a medication (5.1%), preventing a drug interaction (3.3%), and resolving other problems (12.6%). The most common medication classes involved were antimicrobial agents (9.1%), anticoagulants (8%), antihyperglycemic agents (3.8%), other drug classes (24%), and multiple drug classes (35%). Conclusion: A transition-of-care pharmacist is in a unique position to educate patients on hospital discharge, to intercept a substantial number of medication errors, and to resolve insurance issues that may lead to adherence problems. These improvements in care may result in reduced hospital readmission rates.

AB - Objective: To assess the impact of a transition-of-care pharmacist during hospital discharge. Setting: An academic medical center in southern Arizona. Practice description: One pharmacist coordinated patient discharges in two inpatient units from August 2012 through July 2013. The pharmacist attended interdisciplinary discharge coordination meetings, ensured appropriate discharge orders, facilitated the filling of medications, and educated patients on discharge medications. Practice innovation: The implementation of a transition-of-care pharmacist to provide discharge medication reconciliation and education. Main outcome measures: Readmission rates and medication interventions made by the pharmacist at discharge. Results: The pharmacist was involved in the education of 1,011 patients and performed 452 interventions. There were more readmissions per month in the control year versus the year of pharmacist involvement (median 27.5 vs. 25, P = 0.0369). Interventions made by the pharmacist to improve discharge management included starting an omitted medication (23.5%), preventing multiple discharge problems (16.4%), avoiding duplication of therapy (15.7%), correcting insurance issues related to medication coverage (12.2%), changing an improper medication dose or quantity (11.3%), changing an inappropriate prescription for a medication (5.1%), preventing a drug interaction (3.3%), and resolving other problems (12.6%). The most common medication classes involved were antimicrobial agents (9.1%), anticoagulants (8%), antihyperglycemic agents (3.8%), other drug classes (24%), and multiple drug classes (35%). Conclusion: A transition-of-care pharmacist is in a unique position to educate patients on hospital discharge, to intercept a substantial number of medication errors, and to resolve insurance issues that may lead to adherence problems. These improvements in care may result in reduced hospital readmission rates.

UR - http://www.scopus.com/inward/record.url?scp=84936940409&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84936940409&partnerID=8YFLogxK

U2 - 10.1331/JAPhA.2015.14087

DO - 10.1331/JAPhA.2015.14087

M3 - Article

VL - 55

SP - 443

EP - 448

JO - Journal of the American Pharmacists Association : JAPhA

JF - Journal of the American Pharmacists Association : JAPhA

SN - 1544-3191

IS - 4

ER -