Category: Professional Posters
Purpose: Brigham and Women’s Hospital (BWH) pre-operative evaluation clinic (The Weiner Center) serves ~450 patients weekly, including 72 orthopedic surgery patients. There are not enough Nurse Practitioner (NP) office visits available to adequately serve ortho patients in a timely manner contributing to rescheduled surgeries and patient dissatisfaction. Orthopedic surgery patients have a low medication reconciliation rate of 20%. NPs spend ~35 hours/week completing medication reconciliation by phone for ~90 patients prior to clinic visits. Unfortunately, not all patients are reached prior to clinic visits contributing to increased visit time, risk of medication related adverse events, and increased admission rates.
Methods: In February, we began a six-month peri-operative pharmacy-led telehealth medication reconciliation support redesign pilot for pre-operative orthopedic surgery patients. A team of pharmacists and pharmacy interns identified patients in the electronic medical record system to call 12 days prior to their clinic visit. Multiple resources were utilized to collect accurate medication lists. Best possible medication histories were performed over the phone and medication lists were updated accordingly in the electronic medical record. Pharmacies were called if there were discrepancies, patients were unsure of their correct medication regimens, or there seemed to be potential adherence issues. Our aim is to increase clinic visit throughput to decrease lead time for patient appointments by significantly reducing NP medication review time and decrease 85-minute visit length by 10% so the clinic can serve ~5 more patients/day by the end of July.
Results: Four months into the pilot, the pharmacy-led team has completed 455 medication reconciliation support calls, correcting numerous medication errors. The most common types of discrepancies were deletions, followed by omissions, then duplications. The majority discrepancies were found with over the counter products/herbal supplements. Average length of clinic visit time has decreased by 11% (~89 min 79 min) since the start of the intervention, freeing up NPs to do other work. Preliminary data supports this intervention can increase patient access, satisfaction, and workforce efficiency leading to reduced risk of delayed surgeries and medication errors.
Conclusion: Pharmacy-led telehealth medication reconciliation support services offer a high impact, low barrier to entry, cost effective method of optimizing medication management. This model proves that collaborative interdisciplinary redesign processes can foster sustainable solutions to common healthcare challenges promoting patient safety and mitigating risk.