Identify key elements of a successful discharge medication program
Looking to identify key elements of a successful discharge medication program
Pharmacy is a large and complex book of business. With many components, inpatient, retail, specialty, 340b, and mail order service, resource allocation and deployment requires careful consideration. Often times it seems as if these resources function in a silo with little cross coverage between teams. That is the case in our large health system (8 hospitals, multiple retail sites, mail order service, and specialty compounding). We have developed very specialized teams and analyze performance and profitability in each of those areas, but not as a complete book of business.
On the inpatient care part of the business, pharmacy is often part of routine multidisciplinary teams (quality teams, PNT, patient experience, etc). A more recent formed team has a focus of providing discharge prescriptions to patients so that they leave with their meds in hand. The thought is that will help drive patient compliance for taking their medication (and subsequently avoid readmissions). This is often referred to as “meds to beds”, in the industry. We soon discovered that our retail sites (which are on site at each hospital) could not handle the volume, largely because they were spending a lot of time filling employee prescriptions at the counter. We had not forced employees to use mail order service. We fill around 17,000 employee prescriptions each month.
While we now have transitioned to mail order for employee prescriptions and subsequently freed up resources, we are still not gaining expected traction with capturing fill rate of discharge medications. Clearly success in this area relies on more than resources and is very process driven. We are struggling to identify key elements to produce results in discharge medication fill rate success. Additionally, we want to understand if there is an industry benchmark out there for what success in this activity can yield financially.
Having a meds to beds program involves working with all team members to collaborate on making the program successful. When we started our meds to beds program we met monthly to review lessons learned and avoid the situations that cause bottle necking and to assess growth
-scripts are sent first thing in the am prior to discharge or the day before
-patients with complex problems and having multiple prescriptions the process starts the 1-2 days before discharge where the discharge is started and meds are sent to the pharmacy to plan ahead and prepare the patient and family
-We also use telemedicine approach for pharmacists to talk with patients and families and do medication teaching
-The medication delivery is done by techs in the pharmacy right to the bedside however more complex regimens the pharmacist and or nurse will do the education
-our retail pharmacy that is in house utilizes separate staff for employee prescriptions opposed to patient prescriptions. This was a decision made by the pharmacy to help with though put
-The biggest impact that has made our program successful is having the providers put the scripts in several hours prior to anticipated discharge and also noting the time of expected discharge so the pharmacy can best prioritize which scipts need to be filled first.
Thank you very much – the telemedicine for teaching is great!. Also, great point about timing of providers entering scripts.
We were having a similar issue. Within the hospital we were also having issues with incorrect medication/dosage being written. This occurred since the medication history was being completed by an ER nurse who many times did not verify if changes had occurred with medications. To tackle this problem we grouped both issues together. Patients admitted through the ED, we hired pharmacy technicians who completed all medication histories. Therefore, when the physician completed the medication reconciliation, we knew we had 100% accuracy with medications. Once the patient was admitted, we offered prescriptions to be filled at our in-house pharmacy with a discounted rate. This occurred about 75% of the time and allowed “meds to beds” with ease. The remainder 25% had prescriptions sent prior to discharge which allowed a “check and balance” with pharmacy to be sure the medications were accurate and any teaching on how to take the medications. Our compliance rate greatly improved.
We experienced a similar trajectory with employee prescriptions. As in your experience, we no longer provide this service. We also started a bedside delivery pharmacy service staffed by techs. We have been able to capture a higher percentage of discharge prescriptions in this way but the profitability of this service remains elusive. Our greatest success was in filling prescriptions from our 340B clinics in the hospital pharmacy. This strategy has been profitable
The key question that I see in your initial post is the following: are you trying to maximize profits on meds to beds or is the ultimate goal to minimize readmissions? If it is the first, then you have to expand pharmacy capacity to meet the demand. If it is the latter, then you should focus on timely transitions of care to the PCP, who will manage all follow up including medication reconciliation.