Following a patient death several days after discharge to home, HealthSouth Valley of the Sun partnered with a local pharmacy to deliver high-risk medications to patients' bedsides before discharge.
Collaborator (Non-Members)Nina Paasche
Despite our practice of providing discharge counseling that includes solidifying plans for obtaining medications, patients were not consistently filling their prescriptions after discharge. The significance of this issue was reinforced when a patient died post discharge after failing to fill a high-risk medication.
HealthSouth is a rehabilitation hospital in Glendale, Arizona. It is a 75-bed hospital with a focus on speech therapy, physical therapy and occupational therapy as part of the patient’s recovery.
What We Tried
To ensure our patients go home with the right medications, we implemented a plan for bedside delivery of discharge medications. To do this, we established a relationship with a local pharmacy to deliver patients’ medications prior to discharge. This service is offered for all medications and to all patients prior to discharge. At HealthSouth, we place an emphasis on CMS-deemed high-risk medications, which are opioids, anticoagulants and hypoglycemic agents. As an example, with the patient’s permission, we enroll the patients that are prescribed a novel anticoagulant agent such as Xarelto or Eliquis for a savings card through the manufacturer that gives them a free 30-day supply and discounts on refills and provide the patient with the option of having that medication delivered prior to discharge. For our opioid patients, we run their prescription drug monitoring program (PDMP) prior to discharge and notify the pharmacy of their choosing of our findings. We then verify the medication is in stock and identify any barriers the patient might face to filling their prescription, and also present the patient the option of having the medication delivered by our local pharmacy prior to discharge. For our diabetic patients, we put a prescription label on the insulin pen that was being used to care for the patient while they were at our facility and discharge them with it so they have some insulin on hand upon discharge.
By increasing bedside delivery, we aim to reduce hospital readmission rates. Having a high-risk medication delivered to the patient reduces some of the burden of acquiring this medication upon discharge. We hope to see increased adherence for patients on anticoagulants, opioids and hypoglycemic agents by providing this service.
Patients appreciate this service because it reduces the urgency of going to a pharmacy immediately after discharge.
In order to make this work, we recommend beginning this process as soon as possible from the time the patient is admitted to ensure that any problems are able to be resolved prior to discharge. Early conversations with the physicians on potential discharge medications can help streamline this process. Early conversations with patients as to which pharmacy they would like to get their medications filled upon discharge and presenting the option of getting their discharge medications delivered to them prior to leaving the facility also helps this process. We also recommend developing a relationship with a local pharmacy. We hope to expand this process and get more pharmacies involved so we can offer our patients more variety in our bedside delivery service.