VA Palo Alto tailors medication schedules to their patient’s lives to minimize early-dosing.
We noticed that some of our readmissions were experiencing early-dosing on medications. When we sat down with them to understand what was happening, we realized that some of our patients are on “retirement time.” They would wake up at 11am, take their “morning” pill, then have their afternoon pill at 1pm. They didn’t realize that they should shift the entire schedule back a few hours if they started later in the day.
VA Palo Alto is a government-affiliated teaching hospital in Palo Alto, CA. It has 885 beds and serves primarily English-speaking US veterans with comorbidities requiring both acute and chronic care. Their transitions program began in 2012 and is influenced by Project RED.
What We Tried
We started working with patients to understand what a typical day looks like for them and crafted a medication regimen to fit their lives. For example, instead of taking a pill at 9am and 4pm, we might tell them to take it at 11am and 6pm.
We’ve noticed fewer patients who experience early-dosing resulting in hospital visits. Patients are also more likely to adhere to their medication regimens when they were developed around their lives, instead of forcing them to change their habits to take their medications.
To do this well, we had to really take the time to understand what a day in the patient’s life looks like. We can’t assume that everyone is the same. Our staff nurses didn’t have the time to do this, so luckily we had transitions coordinators who could spend more time with each patient.