When a patient is discharged home from a hospital or skilled nursing facility (SNF), it generally signals that his or her condition has improved; the patient no longer requires 24-hour care and his or her health outlook is positive. However, transitioning home, even with family or friends available to assist in medication management, can be fraught with misunderstanding, complications and errors in judgment.
In other words, for millions of Americans, discharge day can be where the trouble starts. Nearly 20 percent of patients experience adverse events within three weeks of discharge, nearly three-quarters of which could have been prevented,according to the Agency for Healthcare Quality and Research.
Post-discharge medication errors make up the majority of these adverse events. In fact, it is estimated that 60 percent of all medication errors occur during transitions from one healthcare setting to another.
But the transition from inpatient skilled nursing care to the home environment can mean big changes for the patients and their caregivers. The prevention of medication errors--which keeps patients healthy and helps to avoid costly, unnecessary hospital readmissions--has become a key focus for healthcare professionals across the country. As our healthcare system rightly has moved toward one that emphasizes coordinated care across multiple disciplines, it simply makes sense to engage in common sense initiatives that offer patients a safeguard--and a second set of eyes after discharge--so that potentially devastating errors can be stopped.
One such initiative, implemented by HealthCare Partners-California, is successfully ensuring that the baton is effectively handed off between discharge from a SNF and the patient’s support network at home. The positive effect it has already had on patients is impressive, and it should serve as a model for all of us in the medical community that cutting-edge programs like this save lives and money. It is a win-win for everyone involved.
The medication reconciliation program developed by HealthCare Partners Pharmacy Services connects a team of pharmacists and pharmacy students with patients discharged from participating SNFs. Within 72 hours of the patient’s return home, a member of the pharmacy team reviews medication discrepancies, discusses possible interventions and develops an action plan, which often includes contacting the discharging physician and providing comprehensive education to the patient and his or her family.
Results of the pilot program, to date, have been remarkable. Of 226 patients discharged during a six-month period in 2014, 79 percent required reconciliation of their medication lists and 53 percent needed some sort of change or intervention to their therapies. Although seemingly minor, the smallest interventions can make a significant difference. Patients who might inadvertently be taking double the dose of a blood thinner or blood pressure medication, or who have failed to begin taking new, critical medicines to treat heart failure or diabetes, can be properly managed by the simple involvement of a knowledgeable pharmacist.
While undeniably beneficial and potentially lifesaving for patients, medication reconciliation programs are also good for Medicare’s bottom line. With billions of dollars lost each year to paying for avoidable hospital readmissions, smart programs such as this one can make a notable difference.
For example, HealthCare Partners saw lower 30-day all-cause readmission rates (8.20 percent) compared to other SNFs in California with similar patient compositions and characteristics, but without a pharmacist medication reconciliation program (15.32 percent). Year-over-year analysis of the intervention program showed a decrease in 30-day acute readmission rates from 10.43 percent in 2013 (pre-intervention year) to 8.20 percent in 2014 (intervention year).
Keeping our patients safe and healthy is an ongoing process that requires multi-disciplinary involvement and unique solutions. Understanding that our responsibility to the patient does not end when they walk out of our doors is the first step toward developing impactful programs that truly make a difference.
In addition to Riya Pulicharam, M.D., HealthCare Partners’ national medical director, the team of Health Care Partners’ Medication Reconciliation Pilot consisted of Linda Aoyoma, M.D.; Riya Pulicharam, M.D.; Chan Chuang , M.D.; Sheila Salamunovich, Pharm.D.; Sylvia Hastanan, B.S.N; and Steve Kawahara, Pharm.D..