330 - Improving availability of discharge medications

Poster Number: 330
Publication Number: 330.323

Amanda Rogers, Medical College of Wisconsin, Milwaukee, WI, United States; Riley S. Boland, Medical College of Wisconsin, Wauwatosa, WI, United States; Sarah Bauer, Medical College of Wisconsin, Milwaukee, WI, United States

Background: Timely access to discharge medications (DM) is an essential step in a safe transition from hospital to home. At baseline our institution has a process where case managers contact pharmacies and families to confirm DM are available and affordable prior to discharge, but many patients are discharged beforehand. This can negatively impact the transition process leading to discharge delays, post discharge safety events, readmissions, and workload inefficiencies for care teams addressing DM issues post discharge.     

Objective: Increase percent of patients whose DM are confirmed as being available and affordable prior to discharge to ≥95% over one year.

Design/Methods: We used quality improvement (QI) methodology with plan-do-study-act cycles at a tertiary pediatric academic medical center to achieve our aim. We reviewed DM related safety events to identify common barriers to DM availability which included prescribing errors, medication/formulation unavailability at preferred pharmacy, cost/coverage concerns, and pharmacy hours. A key driver diagram was used to identify interventions to test including 1. educating care team on common ordering errors and associated risks, 2. electronic health record (EHR) DM decision support tools to guide providers to select commonly available formulations, 3. adding an After Visit Summary (AVS) banner to notify nurses if DM had not yet been confirmed to prevent discharge prior to this being complete, and 4. partnering with an onsite pharmacy to offer extended hours.
 
 
The primary measure was the percent of patients whose DM were confirmed as being available and affordable prior to discharge. Process measure was the percent of DM confirmed as being available and affordable either prior to or after discharge. The balancing measure was length of stay (LOS) to ensure confirming DM availability was not delaying discharges. Statistical process control charts assessed the impact of our interventions.  
 

Results: At baseline, 81% of patients at our institution had DM confirmed prior to discharge. Following interventions of team education and AVS banner notifications, this increased to 90% and 95% respectively, indicating special cause variation. The process measure of DM confirmed either prior to or after discharge improved from 90% to 99% following team education. No change was seen in LOS.
 Conclusion(s): Using QI methodology, we successfully increased the percent of patients whose DM are confirmed as being available and affordable prior to discharge to ≥95%. Next steps include assessing for impact of DM confirmation on discharge delays and post discharge safety events.
Outcome: Percent of patients whose discharge medications (DM) were confirmed as being available and affordable prior to discharge