Category: Federal Forum Posters
Purpose: An electronic discharge solution has been implemented to track patients on opioid therapy during the hospital stay to provide therapy assessment and patient counseling at the time of discharge. The goal is to reduce the duration of opioid therapy at discharge, identify inappropriate prescribing by providers, standardized patient counseling on the risk associated with using opioid medication and have one central location to document interventions by pharmacists during discharge. The electronic discharge solution was also used to alert the pharmacist of 72 hours post discharge for patient follow up as needed for additional drug information or interventions.
Methods: The electronic discharge solution has been integrated with the hospital EHR. Patient will be identified and targeted for discharge counseling if they are going home on opioid therapy. Patient enrolled into the discharge solution and followed throughout their stay. Activities to prepare for discharge counseling is embedded within the discharge solution and is used to alert the pharmacist of scheduled counseling needed at time of discharge. The customized activity template was standardized to facilitate preferred process and used to collect documentation for a successful discharge. The total number of opioid prescriptions at discharge as well as quantity, day supply, prescriber and morphine milligram equivalents will be captured and evaluated. PDMP was also used to analyze opioid refill data at 2 weeks post discharge and electronic reminder schedule for pharmacist to review. A reminder will be made in the discharge system for review of patient survey 72 hours discharge. Patient will be asked about their opioid usage at home and have an opportunity to discuss any medication problems.
Results: Currently 85% of all patients leaving the hospital are counseled by a pharmacist prior to discharge. These included patients going home on opioid therapy. The discharge solution helped to organize and provided focused counseling and enhance the discharge process for patients discharged on home opiate therapy. The total number of opioid prescription, the quantity and day supply of opioid as well as morphine milligram equivalents have to be taken into account. Interventions done during this process will be captured and evaluated for effectiveness. Currently, post discharge follow-up with patient are being done by a nurse 72 hours post discharge with pharmacy questionnaire regarding pain therapy regimen and questions. The pharmacist will review follow-up documentation from nursing for potential intervention. A patient survey will be used to document and verify expected added value of discharge counseling.
Conclusion: Patients leaving the hospital on opioid therapy has to be a main focus for the facility. Having a mechanism to identify patients on opioid therapy while they are in the hospital provides a way to ensure they received focused counseling at discharge and post discharge. We were able to develop achievable standardized process using discharge solution and activity based workflow.