Effect of a Pediatric Prescription Medication Discharge Program on Reducing Hospital Readmission Rates

Abstract

OBJECTIVESTo evaluate the pediatric prescription medication discharge delivery and counseling program, implemented at an 186-bed children's hospital integrated within a larger academic medical center, and its effectiveness on reducing hospital readmissions.METHODS This study was a retrospective chart review of existing data in the electronic medical record from patients <21 years of age who were discharged from our institution between September 1, 2014, and November 30, 2014. Patients who participated in the pediatric discharge program were compared to non-participants. The primary objective was to determine if the patient was readmitted within 30 days. Secondary objectives included time until readmission, diagnosis at discharge, and hospital unit at discharge. RESULTSIn total, 1804 patients were assessed. After exclusions, 932 subjects were included in the analysis. In total, 393 (42.2%) patients participated in the pediatric medication discharge and counseling program, and 539 did not participate. Of the patients who participated in the program, 52 were readmitted within 30 days (13.2%), compared with 67 patients (12.4%) who did not participate in the discharge program, p = 0.717. Patients with the diagnoses of malignancy and kidney injury were more likely to be readmitted within this time frame, and those with the diagnoses of heart defects or cardiology disorders and malignancy were more likely to participate in the pediatric prescription medication discharge program.CONCLUSION Participation in the pediatric discharge medication delivery and counseling program did not reduce hospital readmission rate within 30 days.ABBREVIATIONS EMR, electronic medical record; PCICU, pediatric cardiac intensive care unit; PPMDP, pediatric prescription medication discharge program; RSV, respiratory syncytial virus

Descriptive study of discharge medications in pediatric patients

“…Previous studies have evaluated discharge prescription review programs, but few have qualified the type of medications that children received. 7,[9][10][11] The majority (79%) from our study were discharged from a medical service, and 82.6% were discharged on a maintenance medication. The median (IQR) number of total discharge medications was 3 (2-6), but there was no difference in the overall net change of home medications stopped and new medications added at discharge.…”

“…Currently, our institution does not have a formal medication discharge prescription program (MDPP); other institutions have implemented a program and found positive effects on medication errors and cost-savings. 7,10,11 Most patients were discharged from a medical service, with the primary service being General Pediatrics (62.7%). During the study, there were four General Pediatrics teams, three were teaching teams and one staffed by pediatric attendings.…”

“…20 Previous studies have described the role of pediatric pharmacists on outcomes of discharged patients. 7,10,11 Nguyen et al 11 evaluated the impact of an interprofessional medication discharge program involving a nurse and pharmacist over a 5-month period; the three most common interventions involved clarification of medication orders, assistance in obtaining medications, and dose rounding. As noted, we found that 12.5% of all liquid medications were unrounded and there was a greater number of unrounded liquid medications between trainees versus attending physicians, 17.8% versus 9.5%, p = 0.048.…”

“…Medication counseling at the time of discharge was performed in some studies assessing the impact of pediatric pharmacists. 7,10,11 In 2014, the National Council for Prescription Drugs Programs issued a White Paper regarding the best practice of dispensing oral liquid medications for community pharmacists. 21 They recommended that best practices include counseling for caregivers on appropriate administration and instruction on proper dosing devices.…”

“…Currently, limited studies have evaluated the most common medications and prevalence of unrounded doses prescribed to children upon hospital discharge. 7,[9][10][11] One recent study noted that children with multiple maintenance medications had an increased number of medication discrepancies during transitions of care. 12 The purpose of this descriptive study was to quantify and describe discharge prescriptions in hospitalized children.…”