Implementation of a Discharge Education Program to Improve Transitions of Care for Patients at High Risk of Medication Errors

Abstract

Background: Transitions of care (TOC) points are those where patient outcomes can be affected, especially patients at high risk for medication errors. Pharmacist-led postdischarge telephone counseling positively affects patient outcomes, though challenges exist relating to successful patient contact. Objective: The objective of this study was to develop and evaluate a discharge education service bridging the inpatient and outpatient setting to increase successful patient contact points during the TOC process from hospital to home. Methods: This prospective, single-centered observational study examined the impact of a discharge medication education program on successful telephone follow-up contact. The primary outcome was the percentage of high-risk patients educated at hospital discharge who were successfully reached via follow-up telephone contact within 2 business days of discharge. Secondary end points included hospital readmission rates and patient survey responses. Results: A total of 50 patients were included in the initial evaluation of this service; 78% of patients were successfully contacted within 2 business days after discharge, an increase from a 20% success rate prior to service implementation. At follow-up telephone calls, patients reported taking an average of 16 medications. The 30-day readmission rate was 10% for patients receiving this service, compared with 19% prior to implementation. When asked if they understood the medication component of their care and if they found the TOC service to be satisfactory, 100% and 96% of patients strongly agreed or agreed with these statements, respectively, and none disagreed. Conclusion and Relevance: This service demonstrates how pharmacists can interact with a high-risk population and increase contact points to optimize care at crucial health care transition points.

Ações em saúde propostas em programas de transição do cuidado para idosos: revisão integrativa

“…Nesse enfoque, ao pensar na estruturação de Programas de Transição de Cuidados, voltados para idosos hospitalizados, observou-se concordância entre os autores (Hinch et al, 2021;Poelzl et al, 2021;Gilbert et al, 2021;Crannage et al, 2020;Neu et al, 2020;Baecker et al, 2020;Vearing et al, 2019;Wu et al, 2019;Warren et al, 2019;Huckfeldt et al, 2019;Murphy et al, 2019;Finlayson et al, 2018;Ballard et al, 2018;Robertson et al, 2018;Hanan et al, 2018;Iseler et al, 2018;Low et al, 2017;Takahashi et al, 2016;Heim et al, 2016;Wong et al, 2016;Morrison et al, 2016;Lovelace et al, 2016;Zhou et al, 2015;Low et al, 2015;Mae et al, 2014;Wee et al, 2014;Cheng et al, 2014;Logue et al, 2013;Kind et al, 2012;Shu et al, 2011;Stauffer et al, 2011;Ornstein et al, 2011;Daley et al, 2010) acerca do impacto positivo desses programas, principalmente no que tange à redução das taxas de reinternação hospitalar em até 30 dias (Hinch & Staffileno, 2021;Gilbert et al, 2021;Crannage et al, 2020;Wu et al, 2019;Warren et al, 2019;Huckfeldt et al, 2019;Low et al, 2017;…”

“…Segundo Crannage et al (2020), a inserção do profissional farmacêutico no cuidado multidisciplinar torna-se relevante, a fim de garantir a eficácia de programas de transição do cuidado quanto à gestão de erros de medicação, por parte dos usuários. O farmacêutico é o profissional qualificado e apto a identificar e corrigir discrepâncias em receituários médicos, além de fornecer capacitação para o paciente e supervisão de sua terapêutica medicamentosa, impactando diretamente na redução da incidência de efeitos adversos evitáveis.…”

“…A figura do profissional enfermeiro demonstrou ser igualmente efetiva na supervisão de medicações, sendo descrita por autores (Gilbert, T. et al, 2021;Crannage et al, 2020;Neu et al, 2020;Warren et al, 2019;Murphy et al, 2019;Finlayson et al, 2018;Robertson et al, 2018;Hanan et al, 2018;Iseler et al, 2018;Low et al, 2017;Takahashi et al, 2016;Heim et al, 2016;Wong et al, 2016;Morrison et al, 2016;Lovelace et al, 2016;Zhou et al, 2015;Low et al, 2015;Mae et al, 2014;Wee et al, 2014;Cheng et al, 2014;Logue et al, 2013;Kind et al, 2012;Shu et al, 2011;Stauffer et al, 2011) como essencial no processo de comunicação entre os diferentes níveis da atenção à saúde, no processo de transição do cuidado do hospital para domicílio.…”

“…Essa ação de contato, após alta hospitalar, está presente em uma parcela da amostra de artigos eleita (Crannage et al, 2020;Finlayson et al, 2018;Robertson et al, 2018;Iseler et al, 2018;Low et al, 2015), constituindo-se também como uma ação essencial para efetivar Programas de Transição de Cuidados, sob o formato de acompanhamento telefônico ou visitas domiciliares.…”

Development and evaluation of pharmacist-provided teach-back medication counselling at hospital discharge

“…Patients were eligible to be recruited from eight medical specialties using convenience and purposive sampling. Based on similar previous studies and resource constraints, a sample size of 40 patients was planned in advance [ 3 , 29 ]. No power calculation was performed.…”