Impact of pharmacist intervention on transitions of care from hospital to skilled nursing facility

Abstract

Objective: Medication discrepancies affect 60%-85% of patients discharged from a hospital setting to a skilled nursing facility (SNF). This population also accounts for one-fifth of hospital readmissions. The objective of this study is to identify how involvement of a pharmacist can improve patients' transition from a hospital setting to a SNF. Methods: This prospective study will take place after institutional review board approval is obtained and will occur over a 3-month period. Eligible study participants will consist of patients being discharged from the hospital to a designated SNF. Patients will be excluded from the study if they are <18 years of age, pregnant, or under palliative or hospice care. Approximately 4 days post discharge, the resident will visit the designated SNFs to review and compare the participants' hospital discharge medication reconciliation information with the SNF admission orders. The primary outcome measured will be number of discrepancies identified when comparing the hospital discharge and SNF admission medication lists. When discrepancies are identified, the medical director (or the medical director's designee) will be contacted to reconcile the inconsistencies. The cost avoidance will be calculated based on type of discrepancies identified by the resident. The resident will complete a prospective chart review and recommendations will be communicated to the provider. The number of recommendations made to providers and the acceptance rate of those recommendations will be collected as secondary endpoints. Data on 30-day readmission rate will be collected for study participants and results analyzed. Results: Data will be collected and evaluated using descriptive statistical analysis.