Inpatient Pharmacy Department, Sentara Leigh Hospital, Norfolk, VA.
Inpatient Pharmacy Department, Sentara Virginia Beach General Hospital, Virginia Beach, VA.
Am J Health Syst Pharm. 2020 Jun 4;77(12):979-984. doi: 10.1093/ajhp/zxaa090.
A pharmacist-led process to improve medication management in transitions from acute care to skilled nursing facility (SNF) care is described.
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.
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.
介绍一个由药剂师主导的流程，以改善从急性护理到熟练护理机构（SNF）护理的过渡期间的药物管理。
将患者从急性护理机构转移到 SNF 涉及多个步骤，药物管理可能会延迟。作为医疗系统评估从医院到 SNF 转移后及时进行第一剂给药的障碍的一部分，一个多学科团队的任务是确定高风险药物漏服的频率，并确定药物管理延迟的原因。进行了一项回顾性审查，以评估 2017 年 1 月至 6 月期间从社区医院出院并转入 SNF 的患者的药物医嘱（基线期）。该审查发现，60%的高风险药物的第一剂给药时间超过了规定的给药时间。确定的一个主要障碍是 SNF 入院后在 SNF 电子病历中延迟输入药物医嘱。还观察到，转移患者的 30 天再入院率超过了既定的再入院率目标。为了解决确定的流程障碍，开发了一个由药剂师主导的试点项目。该项目专注于 2018 年 3 月至 5 月期间同一 2 家医院和 SNF 地点的流程改进。药剂师在患者到达 SNF 之前审查、核对和输入药物医嘱。在药剂师实施后，消除了医嘱输入延迟，与基线数据相比，给药时间的平均延迟减少了 68%。发现 51%的转移患者的出院小结中存在药物错误，其中大部分在 SNF 入院前得到澄清和解决。观察到，在试点项目期间，SNF 转移后的 30 天全因再入院率比前一年同期低 10.4%。
通过实施由药剂师主导的从急性护理到 SNF 护理的过渡期间的药物管理流程，可以减少主要障碍，如药物管理延迟和医嘱输入延迟。此外，在患者入院 SNF 之前解决并解决了出院药物错误。
