Category: Health Policy and Systems
Inadequate medication adherence has been shown to result in poor patient outcomes, higher healthcare costs, and increased patient and physician frustration. Studies have investigated interventions to increase overall medication adherence, but few have analyzed primary medication non-adherence (the act of not filling an initial prescription). We aimed to decrease this non-adherence by developing a medication delivery program titled “Meds-to-Beds”. Through this program, medications are delivered directly to the patient’s bedside by the pharmacy on discharge day, ensuring an immediately available 30-day supply of medications. For this interdisciplinary program to function optimally, there has to be timely and effective communication between the physician, charge nurse, and pharmacy.
Our objective was to develop a process map outlining the physician role in the Meds-to-Beds program and to achieve 100% timely charge nurse notification of medication reconciliation (med-rec) completion.
Charge nurses were initially surveyed regarding percentage of timely med-rec notifications. A root cause analysis was performed and individual process maps were developed and compiled into a standardized process map. Areas for improvement were identified and EMR changes were implemented, including development of an electronic physician reminder to complete the med-rec and an automated charge nurse notification upon completion.
Initial survey showed a 71% timely charge nurse notification rate. After implementation of and education regarding the standardized process map, notification rate improved to 83%. After implementation of EMR changes, notification rate improved to 100%.
Through root cause analysis, standardization of the process, directed education, and implementation of electronic reminders and automated notifications, we were able to achieve our goal of 100% timely charge nurse notification of med-rec completion. This institution specific program is a successful model for decreasing primary medication non-adherence that could be replicated elsewhere. Future directions of study include whether this program decreases post-discharge hospital readmission rates, ED visits, or urgent care visits.
Victoria Tran– Resident Physician, Loma Linda University
Kristian Flores– PGY3, Physiatry Resident, Loma Linda University Health
Zachary Carter– Resident Physician, Loma Linda University
Calvin Fesler– Physical Medicine & Rehabilitation Resident Physician, Loma Linda University Health
Jessica Tse– Resident Physician, Loma Linda University
Margaretha Kasim– Charge Nurse, Loma Linda University
Lori Mendoza– Pharmacist, Loma Linda University
Mary Kim– Program Director, Loma Linda University