Pharmacist-led program to improve transitions from acute care to skilled nursing facility care.

PURPOSE: A pharmacist-led process to improve medication management in transitions from acute care to skilled nursing facility (SNF) care is described. SUMMARY: The process of transitioning patients from an acute care facility to a SNF involves multiple steps, with the potential for delays in medication administration. As part of a health system's effort to evaluate barriers to timely first-dose administration after hospital-to-SNF transfers, a multidisciplinary team was tasked with defining the frequency of missed doses of high-risk medications and identifying reasons for medication administration delays. A retrospective review was conducted to evaluate medication orders for patients discharged from a community hospital and admitted to a SNF from January through June 2017 (the baseline period). This review found that 60% of first doses of high-risk medications were given after the scheduled administration time. One major barrier identified was a delay in entering medication orders in the SNF electronic medical record after SNF admission. It was also observed that 30-day readmission rates for transferred patients exceeded established readmission rate targets. To address identified process barriers, a pharmacist-led pilot program was developed. The program focused on process improvements at the same 2 hospitals and SNF sites during the period of March through May 2018. The pharmacist reviewed, reconciled, and entered medication orders prior to patient arrivals to the SNF. After pharmacist implementation, order entry delays were eliminated, and the mean delay from medication due time to administration was decreased by 68% relative to baseline data. The discharge summaries of 51% of transferred patients were found to contain medication errors, most of which were clarified and resolved prior to SNF admission. It was observed that the 30-day all-cause readmission rate after SNF transfers during the pilot program was 10.4% lower than during the same timeframe of the previous year. CONCLUSION: By implementing a pharmacist-led process for medication management in transitions from acute care to SNF care, major barriers such as delayed medication administration and medication order entry were reduced. In addition, discharge medication errors were addressed and resolved prior to patients' admission to the SNF.

GP-VTS half-day release: evaluating a virtual group approach.

WHAT IS ALREADY KNOWN IN THIS AREA • Attendance at the traditional half-day release GP vocational training schemes (VTS) is becoming more difficult because of the European Working Time Directive, flexible working, etc. • There are many other avenues for learning available than just the half-day release. WHAT THIS WORK ADDS • It is possible to set up and run a virtual VTS group using modern technology blended with some meetings for group forming and sharing of project work. • The monitoring evaluation and review cycle can be used to refine such an educational. SUGGESTIONS FOR FUTURE RESEARCH • Further exploration of barriers to participation and possible solutions for individual learners in a virtual group. • How such developments can keep pace with, and make best use of continually developing communication technology.