Adding pharmacy services to a multi-disciplinary discharge team

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1 E3 (EFFECTIVENESS, EFFICIENCY, EXCELLENCE IN HEALTHCARE) GRANT CASE STUDY ALL IN FOR GOOD Adding pharmacy services to a multi-disciplinary discharge team Pharmacists provide medication management support

2 Pharmacist-Managed Discharge Medication Reconciliation When Franciscan Alliance added pharmacy services to a multi-disciplinary discharge team, they improved patient safety and quality of care. Overview of organization Franciscan Alliance is a system of 14 hospitals and multiple medical practices; it services patients in Indiana, Illinois and Michigan. The integrated system provides a coordinated continuum of comprehensive healthcare services. Core to its mission is advocating for those in need and caring for anyone who comes through its doors. Franciscan Alliance Foundation on behalf of Franciscan St. Margaret Health-Hammond Mishawaka, IN Providing pharmacist counseling for our patients at discharge has both increased medication safety and decreased readmissions. We ve now expanded the original pilot program to all major hospitals in our healthcare system. Sun Lee-Such, PharmD, Pharmacy Director 2

3 Project summary Franciscan Alliance has long had multidisciplinary teams, including a physician, nurse, case manager and social worker, providing support to patients as they transition from hospital to home. In 2011, the organization launched a pilot project, adding a pharmacist to the discharge team for medication management support. During the eight-month pilot, the pharmacist had 1,155 visits with patients being discharged from two units and clarified medication discrepancies with nearly every one of the discharged patients. The project was then expanded to 10 of 16 units in two of the health system s major hospitals (St. Margaret Health- Hammond and St. Margaret Health-Dyer). The involvement of pharmacists was so successful in improving patient safety that Franciscan Alliance wanted to extend their services further. In 2013, with support from the Cardinal Health Foundation, Franciscan Alliance began extending pharmacy services hospital-wide, focusing on the transition of care for high-risk patients. At discharge, pharmacists prepared complete medication lists for each patient and provided medication counseling to resolve any discharge discrepancies. The E3 grant funding also provided pharmacistdriven follow up phone calls to the hospital s heart failure patients. The follow up calls allowed pharmacists to identify and remove many barriers to medication therapy. Those patients who had financial, transportation or psychosocial barriers to filling their heart failure prescriptions were given a free 30-day supply of the appropriate medication(s) (angiotensin converting enzyme (ACE) inhibitor, angiotensin II receptor blocker (ARB), beta blocker, diuretic, potassium chloride and/or digoxin). Pharmacists also provided post-discharge disease state counseling for these at-risk patients. 3

4 Project objectives Provide pharmacists-driven medication reconciliation, and medication and disease state counseling for all patients at discharge Provide pharmacists support for heart-failure patients post discharge, through follow-up phone calls Decrease 30-day readmission rates for heart-failure patients Results (for 3,626 participants) Pharmacists clarified at least one medication discrepancy among nearly every patient they interacted with Reduced 30-day hospitalizations from 22% to 16% Reduced 30-day readmission rate from 36% to 27% Hospital days saved: 1,813 Dollars saved: $1,743,229 The summary results are estimates that have been separately prepared and provided by each individual grantee and were based on one year periods unless otherwise noted. 4

5 Project continuation Franciscan Alliance was able to use outcome data collected from the original pilot project in 2011 and the augmented project supported by Cardinal Health Foundation funding in 2013 to gain approval for adding pharmacist-support at discharge systemwide. Today, these two major hospitals in the Franciscan Alliance system include pharmacist interventions for patients at discharge: A total of seven full-time clinical pharmacists provide these services. Pharmacists also provide post-discharge follow-up phone calls with all heart failure patients. Pharmacists are also involved in the Emergency Department, where they receive complete admission medication histories, and on the inpatient units, where they provide a final check-in with patients to resolve any potential discharge discrepancies. Franciscan Alliance Foundation leadership Kevin D. Leahy President and CEO, Franciscan Alliance, Inc. Sun Lee-Such PharmD, Pharmacy Director, Franciscan St. Margaret Health Pharmacists prepare medication lists for patients, and provide medication counseling to resolve discharge discrepancies. 5

6 About the E3 Grant Program Since 2008, through its E3 Grant Program, the Cardinal Health Foundation has invested in hundreds of healthcare organizations across the country. We support a wide array of patient safety work with a focus on accelerating the rate of change with two goals: Improved patient outcomes Reduced healthcare costs Because of the complexities in healthcare and healthcare systems, it takes an average of 17 years for evidence-based practices to be fully implemented into healthcare practices, according to The National Institutes of Health. Within a year or two, some of our grantees are affecting change, eliminating errors and creating lasting improvement. They are reducing readmissions to hospitals, reducing lengths-of-stay and, most importantly, saving lives. For more information, visit cardinalhealth.com/ patientsafetygrants. About the Cardinal Health Foundation The Cardinal Health Foundation supports local, national and international programs that improve healthcare efficiency, effectiveness and excellence and the overall wellness of the communities where the Cardinal Health (NYSE:CAH) nearly 37,000 employees live and work. The Cardinal Health Foundation also offers grants to encourage community service among its employees and works through international agencies to donate much-needed medical supplies and funding to those who need them in times of disaster. Cardinal Health is #AllInForGood. To learn more, visit cardinalhealth.com/community facebook.com/cardinalhealthfoundation 2016 Cardinal Health. All Rights Reserved. CARDINAL HEALTH, the Cardinal Health LOGO and ESSENTIAL TO CARE are trademarks or registered trademarks of Cardinal Health. All other marks are the property of their respective owners. Lit. No. 5CR _7 (09/2016) 6