Pharmacy Discharge Services: A Pilot Project Involving Pharmacist and Pharmacy Technicians at a Pediatric Hospital

摘要

Background: It has been estimated that 30% of all hospital discharges are delayed for non-medical reasons including poor organization of post-discharge health, poor knowledge of social circumstances, and poor communication between the hospital and community pharmacy. Studies have shown that patients are at greater risk for medication errors during transitions of care. A pharmacy discharge planning service has the potential to decrease length of stay, readmission rates due to medication errors, and inappropriate prescribing. Description: The pharmacy department, at our hospital, implemented a pilot project to offer pharmacy discharge services on two units from July 13, 2015 to September 11, 2015-The objectives were to: 1) improve patient flow by reducing medication-related discharge delays, and 2) improve patient safety through education and medication reconciliation at discharge. Patients eligible for the service were "at risk" for: 1) low medication literacy; 2) discharge delays; 3) financial barriers, and 4) non-adherence. Action: The medication reconciliation technician's role was to identify patients eligible for the service. Interventions by the discharge pharmacist included education, illustrated medication calendars, suggesting medication changes to physicians, completing application forms for drug coverage, preparing discharge prescriptions, communicating with the community pharmacy, requesting social work consultation, and providing compassionate drugs. Evaluation: A total of 308 patients were admitted during the pilot phase. Fifty patients were referred to the pharmacy discharge service, the most common reason for referring patients was "complex medication regimens" (36.7%). A total of 73 interventions were made, with the most common being the preparation of discharge prescriptions with communication with the community pharmacy to ensure drug availability (n=32). Implications: Pharmacy technicians and pharmacists play an important role in discharge planning with nearly 1 pharmacist intervention for every 4 patients admitted. Future evaluation will focus on readmission rates, patient and physician satisfaction, drug adherence and patient health literacy.