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Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention.

Publication ,  Journal Article
Gallagher, D; Greenland, M; Lindquist, D; Sadolf, L; Scully, C; Knutsen, K; Zhao, C; Goldstein, BA; Burgess, L
Published in: BMJ Open Qual
March 2022

INTRODUCTION: Reducing unplanned hospital readmissions is an important priority for all hospitals and health systems. Hospital discharge can be complicated by discrepancies in the medication reconciliation and/or prescribing processes. Clinical pharmacist involvement in the medication reconciliation process at discharge can help prevent these discrepancies and possibly reduce unplanned hospital readmissions. METHODS: We report the results of our quality improvement intervention at Duke University Hospital, in which pharmacists were involved in the discharge medication reconciliation process on select high-risk general medicine patients over 2 years (2018-2020). Pharmacists performed traditional discharge medication reconciliation which included a review of medications for clinical appropriateness and affordability. A total of 1569 patients were identified as high risk for hospital readmission using the Epic readmission risk model and had a clinical pharmacist review the discharge medication reconciliation. RESULTS: This intervention was associated with a significantly lower 7-day readmission rate in patients who scored high risk for readmission and received pharmacist support in discharge medication reconciliation versus those patients who did not receive pharmacist support (5.8% vs 7.6%). There was no effect on readmission rates of 14 or 30 days. The clinical pharmacists had at least one intervention on 67% of patients reviewed and averaged 1.75 interventions per patient. CONCLUSION: This quality improvement study showed that having clinical pharmacists intervene in the discharge medication reconciliation process in patients identified as high risk for readmission is associated with lower unplanned readmission rates at 7 days. The interventions by pharmacists were significant and well received by ordering providers. This study highlights the important role of a clinical pharmacist in the discharge medication reconciliation process.

Duke Scholars

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Published In

BMJ Open Qual

DOI

EISSN

2399-6641

Publication Date

March 2022

Volume

11

Issue

1

Location

England

Related Subject Headings

  • Quality Improvement
  • Pharmacists
  • Patient Readmission
  • Patient Discharge
  • Medication Reconciliation
  • Inpatients
  • Humans
  • 4206 Public health
  • 4203 Health services and systems
 

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Gallagher, D., Greenland, M., Lindquist, D., Sadolf, L., Scully, C., Knutsen, K., … Burgess, L. (2022). Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention. BMJ Open Qual, 11(1). https://doi.org/10.1136/bmjoq-2021-001560
Gallagher, David, Maegan Greenland, Desirae Lindquist, Lisa Sadolf, Casey Scully, Kristian Knutsen, Congwen Zhao, Benjamin A. Goldstein, and Lindsey Burgess. “Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention.BMJ Open Qual 11, no. 1 (March 2022). https://doi.org/10.1136/bmjoq-2021-001560.
Gallagher D, Greenland M, Lindquist D, Sadolf L, Scully C, Knutsen K, Zhao C, Goldstein BA, Burgess L. Inpatient pharmacists using a readmission risk model in supporting discharge medication reconciliation to reduce unplanned hospital readmissions: a quality improvement intervention. BMJ Open Qual. 2022 Mar;11(1).

Published In

BMJ Open Qual

DOI

EISSN

2399-6641

Publication Date

March 2022

Volume

11

Issue

1

Location

England

Related Subject Headings

  • Quality Improvement
  • Pharmacists
  • Patient Readmission
  • Patient Discharge
  • Medication Reconciliation
  • Inpatients
  • Humans
  • 4206 Public health
  • 4203 Health services and systems