利用门诊药房减少儿科哮喘住院患者的药物浪费。
Leveraging the Outpatient Pharmacy to Reduce Medication Waste in Pediatric Asthma Hospitalizations.
机构信息
Washington University School of Medicine, Department of Pediatrics, St. Louis, Missouri. Formerly Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
出版信息
J Hosp Med. 2020 Jan 1;15(1):28-34. doi: 10.12788/jhm.3275. Epub 2019 Aug 16.
BACKGROUND AND OBJECTIVE
Previous local quality improvement focused on discharging patients with inhaled corticosteroids (ICS) "in-hand" decreased healthcare reutilization after hospitalization for an asthma exacerbation. However, as a result of these new processes, some patients admitted for an asthma exacerbation received more than one ICS inhaler during their admission, contributing to medication waste and potential patient confusion regarding their discharge medication regimen. We sought to decrease this waste.
METHODS
We conducted a quality improvement project to reduce the prescribing of multiple ICS inhalers to patients at a large academic children's hospital. Our primary outcome measure was the monthly percentage of patients admitted with an asthma exacerbation who were administered more than one ICS inhaler. A secondary outcome measure evaluated the reliability of the new process of using the hospital-based outpatient pharmacy to supply ICS "in-hand" and verify insurance coverage. After the process map review, we hypothesized a delay in the initial ICS treatment decision would allow for both a finalized discharge medication plan and a standardized process to verify outpatient insurance coverage.
RESULTS
The mean percentage of patients receiving more than one ICS inhaler decreased from our baseline of 7.4% to 0.7%. Verification of outpatient prescription insurance coverage via the outpatient pharmacy increased from 0.7% to 50%. The average inpatient cost (average wholesale price) for ICS decreased by 62% to $90.25.
CONCLUSIONS
Our process change to use the outpatient pharmacy to dispense and verify insurance coverage for ICS medication was associated with a reduction in medication waste during admission for an asthma exacerbation.
背景与目的
之前针对吸入性皮质类固醇（ICS）出院方案的局部质量改进，重点是让患者在出院时能够“即刻使用”ICS，从而减少哮喘加重住院后的医疗再利用。然而，由于这些新流程的实施，一些因哮喘加重而住院的患者在住院期间接受了一种以上的 ICS 吸入器，导致药物浪费，并可能导致患者对出院药物治疗方案感到困惑。我们试图减少这种浪费。
方法
我们开展了一项质量改进项目，以减少一家大型学术儿童医院给哮喘加重患者开多种 ICS 吸入器的情况。我们的主要结果测量指标是每月因哮喘加重而住院的患者中，接受一种以上 ICS 吸入器治疗的患者比例。次要结果评估了使用医院门诊药房供应 ICS“即刻使用”并验证保险覆盖范围的新流程的可靠性。在流程图审查后，我们假设延迟初始 ICS 治疗决策将允许制定最终出院药物计划，并制定标准化流程来验证门诊保险覆盖范围。
结果
接受一种以上 ICS 吸入器治疗的患者比例从基线的 7.4%降至 0.7%。通过门诊药房验证门诊处方保险覆盖范围的比例从 0.7%增加到 50%。ICS 的平均住院费用（平均批发价格）下降了 62%，至 90.25 美元。
结论
我们改变流程，使用门诊药房发放和验证 ICS 药物的保险覆盖范围，与哮喘加重住院期间药物浪费的减少有关。
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