Ensuring Patient Safety at Hospital Discharge

September 7, 2017

Marilyn Stebbins, PharmD, a professor in the department of clinical pharmacy at the University of California, San Francisco (UCSF), focuses on improving patient safety by ensuring medication lists are current and accurate at hospital discharge and during transitions of care.

Medication use must be constantly monitored and optimized for individual patients, according to Dr. Stebbins, who helps run a program at UCSF that tracks and responds to concerns newly discharged patients have about their prescribed therapies.

Dr. Stebbins took a few minutes to discuss the benefits of that program and other ways patient care teams can ensure medications are used safely and properly.

How does the follow-up phone call program work and how does it help identify potential medication side effects?

It’s an automated voice response program that calls patients within 48 hours of discharge. Three of the questions patients are asked relate to medication use: Did they pick up their prescribed medications? Did they start their prescribed therapies? Do they have any questions or concerns about the medications they’re taking? It’s been a great screening and teaching tool that has helped us figure out how to improve our processes at discharge and transitions of care. We also hear back from patients about the side effects and adverse events they experience.

The first step to fixing a problem is identifying it, and we’re able to identify mistakes very quickly and work with patients to ensure their medication regimen is safe and effective. Medication safety data is compiled during clinical trials performed on controlled patient populations. When medications are used in actual practice, the building of adverse drug event databases relies on healthcare providers and patients reporting unintended reactions and side effects. The health care system is fragmented, providers are extremely busy, and reporting is time-consuming, so many adverse events are underreported or unreported. The reporting process needs to be streamlined and maximized, so medication data are more reflective of what’s actually occurring in the real-world setting.

Is ensuring medication safety more challenging now than ever before?

I think so, because Baby Boomers are aging into the Medicare patient population and have increasing numbers of chronic diseases, which require medications to manage. Providers have to assess how the many drugs they’re prescribing interact with other drugs and diseases, and how all of those factors interplay with the complexities of today’s health care system. Medication safety has always been important, but healthcare professionals, patients, and the media are now more hypervigilant about the issue.

Interview continues on page 2