Transcript Home Sweet Home: Pharmacy Innovations to

Home Sweet Home:
Pharmacy Innovations to
Reduce Readmissions
Owensboro Health Outpatient Pharmacy (OHRx)
Jessika C. Chinn, PharmD
Clinical Pharmacy Manager
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Healthcare Cost & Utilization
Health care reform targets hospital
readmissions as a key area for improving
care coordination and potential savings
 3.3 million US adult hospital readmissions
in 2011
 $41.3 BILLION in hospital costs
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Orzag PR, Emanuel EJ. Health
care reform and cost control.
NEJM 2010 363(7): 601-3
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PRINCIPAL DIAGNOSIS
CHF, nonhypertensive
# all cause 30
day
readmissions
134,500
Septicemia (except in labor)
92,900
Pneumonia (except TB or STD)
88,800
COPD
77,900
Cardiac dysrhythmias
69,400
Urinary Tract Infections
56,900
Acute unspecified renal failure
53,500
Acute myocardial infarction
51,300
Complication of device/implant/graft
47,200
Acute cerebrovascular disease
45,800
Total
718,100
Top 10 CMS 30 Day Readmissions
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1 in 6 Medicare patients
are readmitted within 30
days of discharge.
Dartmouth Atlas Project, news
release, September 28, 2011
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Receiving no follow-up care
Not understanding discharge instructions
Problems with medications
Lack of timely follow-up appointments
Unmet post discharge needs
Poor communication (especially with
primary care provider)
Why Readmissions Occur
www.pharmacist.com/node/264576
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Role of the Pharmacist:
shown to reduce readmission
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Comprehensive medication reviews (CMR)
Patient and caregiver education
Medication therapy management (MTM)
Medication counseling by pharmacists
(before & after discharge)
Medication reconciliation
www.pharmacist.com/node/264576
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Discharge Huddles
Discharge Medication Reconciliation
Emergency Department Technicians
72 hour post discharge follow up calls
Standardized discharge process
Role of OHRx
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Pharmacist-led interdisciplinary rounds
Pilot 2015
Spread to 6 units 2016
Communication about medications
Templates for day of discharge, day 3,
and palliative care
Discharge Huddles
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Discharge Rounds
Date:
Attendance at discharge meeting: (Choose all that apply) Nursing, Dietary, RT, Inpatient Pharmacy, Outpatient
Pharmacy , PT/OT, Social Work, Discharge Planning, Chaplain, GRADD
Planning session outside of patient room:
Anticipated Discharge Date:
What is patient’s admitting diagnosis?
Interview of patient/family /care team inside patient room:
Discharge arrangements:
If discharge is today, what is the agreed time?
Will you be returning “home” or have other arrangements been made or need to be made?
What are your discharge transportation plans? (How will patient get to discharge destination?)
Who will be helping you after discharge?
Therapies and Medical Equipment Needs:
Were you receiving care services like home health prior to admission and if so, for what?
Do you need assistance from physical, speech or respiratory therapy?
Do you need any special equipment at home (ie walker, commode, oxygen, shower chair)?
Will this equipment be delivered to the hospital prior to discharge or directly to home?
Do you need any resources such as a Living Will Packet, Senior Options Packet, Financial Packet?
Dietary:
Will patient likely go home on a restricted diet or need dietary consult?
Would you like information regarding your diet?
Pharmacy:
Do you have any questions about your home medications or medications you are currently on?
Is the patient receiving any high risk medications such as (anticoagulants, insulin, chemotherapy) that would need further
education?
What pharmacy is used? Are any paper scripts needed or will all meds be e-scribed?
Does the patient have any bulk meds that need to be ordered for home?
Spiritual:
Are there any persistent emotions that the chaplain can help you address?
Would you like a chaplain to come back?
Patient Satisfaction:
What are your concerns about going home?
Have there been any concerns about your care during this hospital stay? (Follow up with nursing supervisor or manager.)
Items Needing Follow up after discharge rounds:
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2015 Success Share Goal 50%
 December 83%, January to April >90%
 Incorporation with Discharge Huddles
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Discharge Medication
Reconciliation
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Future
Developments
Concierge pharmacy services
 MTM service expansion
 ACO integration
 PEA solutions
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Challenges
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Staffing & resources
Documentation
Acceptance
Consistency
Timing
Efficiency
Reimbursement
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For me?
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 Tearing
down silos
 Big picture
 Perspective
Multidisciplinary
Teams
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Every Patient
Every Time
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QUESTIONS?
Jessika C. Chinn, PharmD
OHRx Clinical Pharmacy Manager
(270) 417-6701
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