Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention

BMJ Open Quality

article

David Gallagher¹  Maegan Greenland²  Desirae Lindquist²  Lisa Sadolf²  Casey Scully³  Kristian Knutsen³  Congwen Zhao⁴  Benjamin A Goldstein⁴  Lindsey Burgess² 

[1] Medicine , Duke University School of Medicine;Pharmacy , Duke University Hospital;Performance Services , Duke University Health System;Department of Biostatistics and Bioinformatics , Duke University;Duke Clinical Research Institute , Duke University

关键词: medication reconciliation;    hospital medicine;    transitions in care;    pharmacists;   

DOI  :  10.1136/bmjoq-2021-001560

学科分类：药学

来源: BMJ Publishing Group

【 摘 要 】

Introduction Reducing unplanned hospital readmissions is an important priority for all hospitals and health systems. Hospital discharge can be complicated by discrepancies in the medication reconciliation and/or prescribing processes. Clinical pharmacist involvement in the medication reconciliation process at discharge can help prevent these discrepancies and possibly reduce unplanned hospital readmissions.Methods We report the results of our quality improvement intervention at Duke University Hospital, in which pharmacists were involved in the discharge medication reconciliation process on select high-risk general medicine patients over 2 years (2018–2020). Pharmacists performed traditional discharge medication reconciliation which included a review of medications for clinical appropriateness and affordability. A total of 1569 patients were identified as high risk for hospital readmission using the Epic readmission risk model and had a clinical pharmacist review the discharge medication reconciliation.Results This intervention was associated with a significantly lower 7-day readmission rate in patients who scored high risk for readmission and received pharmacist support in discharge medication reconciliation versus those patients who did not receive pharmacist support (5.8% vs 7.6%). There was no effect on readmission rates of 14 or 30 days. The clinical pharmacists had at least one intervention on 67% of patients reviewed and averaged 1.75 interventions per patient.Conclusion This quality improvement study showed that having clinical pharmacists intervene in the discharge medication reconciliation process in patients identified as high risk for readmission is associated with lower unplanned readmission rates at 7 days. The interventions by pharmacists were significant and well received by ordering providers. This study highlights the important role of a clinical pharmacist in the discharge medication reconciliation process.

【 授权许可】

CC BY-NC|CC BY|CC BY-NC-ND