RESUMO
OBJECTIVE: This study aims to characterize the impact of a pharmacist-driven discharge medication reconciliation and counseling program targeting high-risk pediatric patients to mitigate barriers in transitions of care. METHODS: This was a single-center quality improvement initiative including high-risk pediatric patients within a large academic medical center. Pharmacy, medical, and information technology team members developed a scoring system to identify patients at high risk of hospital readmission that resulted in a trigger tool built within the electronic medical record (EMR). Pharmacy workflow, the EMR documentation, and staff training were implemented. The primary end point was the number of high-risk patients with complete medication reconciliation and/or discharge counseling performed during the first 2 months after implementation. The secondary end points included quantification and qualification of the interventions conducted by a pharmacist. RESULTS: Pediatric clinical pharmacists conducted discharge medication reconciliation and/or counseling for 60 patients during the first 2 months after implementation. There were 65 interventions performed, including 60 discharge medication reconciliations and 5 discharge counseling sessions. Of these interventions, 22 were recommendations on appropriate medication dosing and frequency (37%), 12 on duration of therapy (20%), and 8 were medication additions (13%). There were 6 interventions on adherence assistance (10%), 6 involved selection of medication formulation (10%), 3 involved medication discontinuation (5%), 2 involved appropriate therapy selection (3%), and 1 involved medication stability (1%). All interventions were accepted and implemented by the prescribing providers. CONCLUSIONS: Pharmacist-driven discharge medication reconciliation and counseling programs targeting pediatric high-risk population might be an effective tool to mitigate gaps in transitions of care.
RESUMO
OBJECTIVES: The purpose of this study is to determine how frequently children's hospitals in the United States are using pharmacist-physician collaborative drug therapy management (CDTM), and to characterize their use in this population. METHODS: A phone survey was created to collect data regarding the use of pharmacist-physician CDTM at children's hospitals. Children's hospitals were called between February 2014 and April 2014. Data were collected from either a clinical pharmacist or pharmacy director. Pharmacists were asked to answer questions regarding hospital demographics as well as to what extent and for which medications they use CDTM. Differences between types of hospitals were evaluated using Fisher exact test. RESULTS: A total of 171 children's hospitals were identified; 51.5% hospitals (n = 88) completed the survey. Of the 88 hospitals that completed the survey, 32 (31.7%) had some level of CDTM in place. Of the 28 children's hospitals with CDTM in place that completed the survey, all allowed pharmacists to modify doses and monitor therapy, and 75% provided pharmacists with the ability to initiate the first dose. The specific medications that were included in the CDTM protocols in children's hospitals included vancomycin (n = 23), aminoglycosides (n = 22), anticoagulation medications (n = 7), and total parenteral nutrition (n = 3). Training was required for pharmacists to participate in CDTM protocols at most hospitals (n = 26). Lack of support from medical staff was the most common perceived barrier. No differences were identified between types of children's hospitals. CONCLUSION: CDTM protocols are practiced in about one third of the children's hospitals. Pharmacists commonly initiate, monitor, and modify therapies as part of these protocols. The most frequently included medications were vancomycin and aminoglycosides.
