Category: Professional Posters
Purpose: Evaluate the role of the pharmacist in medication reconciliation at discharge.
Methods: This prospective study of WVU Medicine’s Meds to Beds program during a patients discharge process show the clinical and financial benefit to the patient. Medication reconciliation strategies during the discharge process shows the time a pharmacist spends reviewing the patients medication improves patient outcomes. Unintentional prescribing of medications for home without the knowledge of the patient’s insurance or home medication prove to cause more confusion to the patient and lead to readmission. The primary goal is to determine the time spent on discharge medication reconciliation would improve patients’ outcome. A large part of improved outcome is making sure medication therapy is appropriate and medication accessible to the patient. This includes making changes to the patient’s prescriptions to match the patient’s insurance. When medications are prescribed, little is known by the prescriber whether the patient can afford the mediation or whether this is the preferred medication for the insurance formulary. Discharge reconciliation taken while still inpatient and patient’s current home medication decreases the likelihood of adverse effects and duplicate therapies from prescribed medication after discharge. The discharge pharmacist plays a significant role to reduce excessive dispensing of incorrect medication and can make medication affordable to patients.
Results: Chart studies were utilized to determine which medications were prescribed as well as test claims were done on prescription to see if insurance coverage was affordable to the patient. Review of what was prescribed was analyzed for possible adverse effects and counseling was done on patients prior to discharge or at delivery.
Conclusion: Patients discharged and use the med-to beds program received clinical benefit in their overall care. Discharge Pharmacists performed medication reconciliation on 130 patients. Pharmacists areas of intervention were duplicate therapy; drug-drug interaction; Sub-therapeutic dosing; teaching opportunities and changes to prescriptions due to preferred insurance medication equivalents. It was found over 35 percent of patients had an issue with what was prescribed. And 20 percent had their medication changed due to payer formulary or preferred med list. The discharge pharmacists’ role in the patient discharge process including medication education; reconciliation; payer formulary review improves the outcome of patients care after discharge.