Hospital brings discharge meds to the bedside
Initiative aims to prevent readmissions, errors
To ensure that patients get their medication at discharge and that the prescriptions are reconciled with current and home medications, Strong Memorial Hospital at the University of Rochester (NY) Medical Center has established a pharmacy program that brings pharmacy services to the bedside at the time of discharge.
"Failures and delays in filling prescriptions at the time of hospital discharge contribute to poor outcomes and readmissions. In addition, errors in discharge prescriptions are common and contribute to adverse events and poor patient outcomes. We started this program to improve the discharge process, ensure that patients have access to the medications they need, and decrease the 30-day readmission rate," says Carrie Polandick, RPh, staff pharmacist at the 900-bed hospital. The pharmacy program covers 500 beds.
Polandick works with four pharmacy technicians, who visit the patient floors to coordinate discharge times with care coordinators and deliver the medications to the bedside. The technicians have a minimum of five years experience and have passed the New York State certification exam. They are equipped with cell phones and pagers and are assigned to a floor, covering five units.
The program fills about 75% of the prescriptions that patients at Strong Memorial Hospital are given. "We work on 30 to 80 discharges a day, and the last time we tallied it, we were filling about 2,000 prescriptions a month," Polandick says.
Each morning, the pharmacy technicians get a list of patients, go to the floors, and meet with the care coordinators after each unit's rounds to find out which patients are being discharged and the approximate time they'll be leaving.
The technicians return to the hospital's outpatient pharmacy and assist Polandick as prescriptions come in. Prescriptions are printed out on the unit and sent to Polandick via pneumatic tube by the care coordinator or the nursing staff. Each floor places a different color sticker on the prescriptions to distinguish the discharge prescriptions from the other prescriptions the department receives.
Polandick reviews all the prescriptions for errors and drug interactions and reconciles them with current and home medications. "I routinely detect errors in the prescriptions and work with the provider to get them corrected before the prescriptions are filled. When a patient takes a prescription to a community pharmacy and the pharmacist finds that the dose is wrong or the drug interacts with another drug the patient is taking, it is difficult to correct from the outside. We take care of these problems when the patient is still in the hospital," she says.
The pharmacy techs prioritize the prescriptions according to the expected discharge time.
"We may have a day to fill prescriptions or need to get them done in 15 minutes, depending on when the discharge orders are written and when the patient's transportation home arrives," she says.
Polandick and the pharmacy tech communicate back and forth during the day with the care coordinators on the unit. For instance, if a drug is expensive or a patient has a high co-pay, the technicians can work with the care coordinator or social worker to provide a coupon from a drug manufacturer or link the patient with the hospital's patient assistance fund.
When patients are ready for discharge and their transportation home arrives, the care coordinators notify the technicians. The pharmacy technicians gather the prescriptions along with change if the patient is paying cash. Otherwise, they take the credit card machine, deliver the medication, and obtain a signature.
Bedside delivery of medication is a convenience for patients and families as well, Polandick says. "Patients want to go home and go to bed when they are discharged. When they go home with their medication, they don't have to wait for the prescription to be filled or stay at home alone while their caregiver goes to the pharmacy. The nurses also like the program because they know that patients are going home with what they need to succeed," she says.