A bedside medication delivery service increased the percentage of asthma patients discharged with medications in hand from 0% to 75%, which helped prevent emergency department readmissions within the next month, according to an exploratory, retrospective analysis.
“To our knowledge this report is the first to detail specific strategies to reliably discharge patients with meds in hand,” said Dr. Jonathan Hatoun of Boston University Medical Center and his associates. “Although this study was not designed to detect adherence, families may feel more comfortable administering medications after receiving teaching from and having questions answered by their inpatient nurse, using the same medications and equipment they will use at home.”
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Before the intervention, the hospital previously had routinely discharged asthma patients without medications in hand, and in 2011, a survey showed that 37% never filled their prescriptions. Concerned that patients were “unnecessarily suffering,” Dr. Hatoun and his associates assembled a multidisciplinary team that worked for 2 years to improve this outcome measure. They initially asked residents to write prescriptions at least a day before discharge, but they were concerned that treatment plans could change. Next, they asked families to pick up medications at the hospital pharmacy, but parents were reluctant to leave their sick child’s bedside. Therefore, the researchers designed an in-room service in which pharmacists delivered the medications to the child’s room when a parent was present (Pediatrics 2016 Feb 24. doi: 10.1542/peds.2015-0461). “Copayments were collected in the room, either in cash or with a mobile credit payment system purchased by the pharmacy,” the researchers explained. “Unlike traditional pharmacy pickup, the delivery service allows the patient, parent, nurse, and pharmacist to be together in the patient’s hospital room for teaching with the actual medications available for demonstration.”
The delivery service not only met the project goal to increase the “meds in hand” rate from 0% to 75%, but an analysis of patients with complete insurance claims showed that patients discharged with medications in hand were significantly less likely to return to the emergency department within 30 days of discharge, for any reason, compared with patients who received usual care (odds ratio, 0.22; 95% confidence interval, 0.05-0.99).
“Although more evidence on the impact of being discharged in possession of discharge medications is needed, a service that provides admitted patients with their outpatient medications before they leave the hospital has many potential benefits,” the investigators noted. “Additional areas of exploration could include how the Meds-in-Hand service affects the patient experience, hospital finances, and clinical outcomes for other medical conditions.”
The authors had no external funding sources or disclosures.