Medication-related Readmissions Research Articles

Impact of Pharmacist-Conducted Medication Reconciliation at Discharge on Readmissions of Elderly Patients With COPD

Beginning in fiscal year 2015, the Centers for Medicare and Medicaid Services will measure all-cause readmissions for patients admitted for exacerbation of chronic obstructive pulmonary disease (COPD). Hospitals will incur a payment penalty for unplanned 30-day readmissions. Elderly patients frequently present a challenge because of polypharmacy, which contributes to a greater risk for medication-related readmissions. To determine whether pharmacist-conducted medication reconciliation at discharge decreased medication discrepancies and reduced 30-day readmissions for elderly patients with COPD. Patients aged 65 years and older admitted for a COPD exacerbation between January 31, 2012, and February 29, 2012, were included. The pharmacist reviewed the discharge form for discrepancies. Patients who were readmitted within 30 days of discharge were identified. The rate of 30-day readmission was compared with baseline data. Length of stay and cost for admission versus readmission were also assessed. A total of 29 patients were admitted for a COPD exacerbation; 6 medication discrepancies were identified and reported to prescribers. Four patients were readmitted within 30 days of discharge. The 30-day readmission rate was lower than the baseline rate (16.0% vs 22.2%). When comparing admissions with readmissions, a slight reduction in average length of stay and slight increase in cost was observed. Pharmacist-conducted medication reconciliation at discharge decreased discrepancies for elderly patients admitted for exacerbation of COPD. The 30-day readmission rate could be decreased further by expanding pharmacist responsibilities during transitions of care. This includes patient counseling, tracking outpatient adherence, selecting affordable medications, and expanding the process to include other chronic disease states.

Quality improvement through implementation of discharge order reconciliation

A coordinated multidisciplinary process to reduce medication errors related to patient discharges to skilled-nursing facilities (SNFs) is described. After determining that medication errors were a frequent cause of readmission among patients discharged to SNFs, a medical center launched a two-phase quality-improvement project focused on cardiac and medical patients. Phase one of the project entailed a three-month failure modes and effects analysis of existing procedures discharge, followed by the development and pilot testing of a multidisciplinary, closed-loop workflow process involving staff and resident physicians, clinical nurse coordinators, and clinical pharmacists. During pilot testing of the new workflow process, the rate of discharge medication errors involving SNF patients was tracked, and data on medication-related readmissions in a designated intervention group (n = 87) and a control group of patients (n = 1893) discharged to SNFs via standard procedures during a nine-month period were collected, with the data stratified using severity of illness (SOI) classification. Analysis of the collected data indicated a cumulative 30-day medication-related readmission rate for study group patients in the minor, moderate, and major SOI categories of 5.4% (4 of 74 patients), compared with a rate of 9.5% (169 of 1780 patients) in the control group. In phase 2 of the project, the revised SNF discharge medication reconciliation procedure was implemented throughout the hospital; since hospitalwide implementation of the new workflow, the readmission rate for SNF patients has been maintained at about 6.7%. Implementing a standardized discharge order reconciliation process that includes pharmacists led to decreased readmission rates and improved care for patients discharged to SNFs.