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UAMC – Discharge Medication Optimization

UAMC – Discharge Medication Optimization. Lauren Miller, PharmD. Instructor University of Arizona College of Pharmacy Clinical Staff Pharmacist Ambulatory Services, UAMC Hospital. Pharmacist Pilot Program: From Discharge to the First Refill. One full time pharmacist 2 inpatient units

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UAMC – Discharge Medication Optimization

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  1. UAMC – Discharge Medication Optimization Lauren Miller, PharmD. Instructor University of Arizona College of Pharmacy Clinical Staff Pharmacist Ambulatory Services, UAMC Hospital

  2. Pharmacist Pilot Program:From Discharge to the First Refill • One full time pharmacist • 2 inpatient units • focused on discharges only • Attend daily care coordination meetings on each floor with nurses, case managers, and social workers to identify high risk patients and plan safe discharges from admission

  3. Responsibilities • Review discharge medication orders • Duplicates • DDI • Missing medications or prescriptions • Remove unnecessary meds • Coordinate prior authorizations ahead of time and assist patients unable to afford meds • Assist patients to fill at hospital pharmacy so they can leave with all new medications • Counsel on medications and education on disease states at bedside

  4. What has worked…. • Team based transitions of care with nurses, case managers, social workers, and MD all involved • All members of the above team now rely on me to assist more difficult discharges and alert me to patients who need my assistance • Good response from patients who like getting their medication problems resolved prior to discharge

  5. Challenges • How to determine when discharge order is in • Subscribe to discharge pager for both units • Have nurses contact me • Have to wait until discharge is finalized to review meds for accuracy • Multiple patients can be discharged at the same time how to see all of them • Getting MDs on board with new program

  6. Examples of Errors Caught • Numerous DDI when home meds restarted • Discharges with duplicate meds • Patients discharged without scripts for new meds • New diabetics leaving without Rx for meters or syringes • Patients leaving without INR follow-up for new start coumadin • Provide assistance to patients unable to afford or changing to meds patients can afford • Incorrect dosing on discharge meds

  7. Data Being Collected • Number of patients interacting with discharge pharmacist including: • Number of meds counseled on • Type of error that was caught and class of medication • If insurance authorization was needed • Amount of time spent on each discharge • Readmission rates before and after • HCAHPS scores • Patients ranking of communication about medications (from hospital survey after discharge)

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