Health Systems

A Discharge Story

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Expanding the role of pharmacy at discharge and the impact on patient care.

This is the story of how one hospital turned a 30-day pilot program into a one-year pilot. And how that one-year pilot became a house-wide, pharmacist-driven program for medication reconciliation at patient discharge and a PPMI case study for evolving the role of the pharmacy technician1 and innovating the pharmacy practice model.2 Curious? Every health system should be.

The Challenge
Once upon a time, there was a 550-bed hospital and medical academic center struggling with elevated readmission rates. To identify opportunities for improvement, patient care processes were put under the microscope.

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The Opportunity
While the hospital used an integrated, decentralized inpatient pharmacy practice model, which provided admission medication reconciliation and limited medication education to patients, it had not integrated pharmacy technicians into the discharge process.

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The Experiment
The hospital decided to temporarily relocate its ambulatory care pharmacist to the inpatient care team.

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The Goals
1. Improve and expand services provided, such as timely discharge prescription processing, delivery of bedside medications and the promotion of patient access to medication through prior authorization assistance.

2. Ensure safe and effective care transitions and patient satisfaction throughout the discharge process.

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The Execution
For 30 days, the ambulatory pharmacist, now serving as a discharge pharmacy technician, performed medication reconciliation at discharge to ensure there were no discrepancies before the patient was discharged from the hospital.

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The Value Add
The technician also sent the discharge scripts to one of the hospital's three on-site pharmacies now focused on discharge patients, enabling the hospital to dispense discharge medications before patients went home.
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The Results

The one-year pilot revealed a wealth of positive results, so much so that the health system decided to implement the discharge pharmacy program house-wide.

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The End (Lesson)
Consider what happens when the definition of an inpatient and outpatient pharmacist is broadened. When a health system pharmacist is just that - an amalgam of medication expertise that can be made relevant at any point in the continuum of care. And for those health systems unsure of the impact an end-to-end integrated pharmacy practice model might have, the answer may be an experiment away.

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Editor's note: At the time of publication, Dr. Patel served as Director of Ambulatory Pharmacy Services for the hospital in this story.

1Advanced Pharmacy Technician Practice Model Case Study. ASHP. ND. Available online at http://www.ashpmedia.org/ppmi/docs/casestudy-Advanced-Technician-Roles-Case-Study-Froedtert.pdf. Accessed 18 January 2016.
2 Practice Spotlight: Froedtert Hospital & the Medical College of Wisconsin Hospitals. ASHP. ND. Available online at http://www.ashp.org/DocLibrary/PPMI/Practice-Spotlight-Froedtert-Medical-College-WI.pdf. Accessed 18 January 2016.
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