Improving Medication Safety for Discharged Patients

May 30, 2017

Can a single phone call from a pharmacist improve medication safety for patients recently discharged from the hospital? Terry Dunn, PharmD, clinical assistant professor at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences, is about to find out. She’s launching a study that will attempt to show the benefits of giving pharmacists an active role in the transition of patient care from the hospital to home, and how the follow-up phone calls they make to discuss medication use with patients can limit unplanned hospital readmissions and emergency room visits within 30 days of discharge.

Dr. Dunn plans to complete the research within a year. If the phone calls have a positive impact on patient outcomes, Dr. Dunn hopes to increase pharmacist involvement in transitions of care by putting them in charge of managing medication regimens during routine hospital discharge.

How will you conduct the study?

We’re starting off by assessing diabetic patients, half of whom will receive a follow-up phone call from pharmacists 48 to 96 hours after discharge to discuss their medication use. The other half will not receive the intervention. The patients will otherwise receive the same care and identical discharge directives. We’ll be looking to see if the phone calls have any impact on unexpected hospital utilization. We decided to focus our initial efforts on patients with type 2 diabetes, because they often have other comorbidities, such as hypertension, that require treatment with several types of medications. It makes sense that the more medications patients are on, the more confused they might be about the proper way to take the prescribed therapies.

What problems are you attempting to solve with respect to discharge transitions of care?

Patients receive incredible amounts of information at discharge, which is a busy and often emotional time filled with potential distractions. How can they possible keep track of every directive they’re told? But once they’re home and have had a chance to relax and regroup in their own environment, they’re much more receptive and ready to review drug information. Our hope is that the phone calls increase patients’ understanding of the medications they should be taking, how they should be taking them, and which therapies should be continued after discharge. Medication regimens are often adjusted when patients are hospitalized. When patients return home, they automatically resume taking the therapies they had been taking before, even though some might no longer be appropriate. The ultimate goal of the phone call intervention is to decrease the potential adverse side effects of the medications patients are prescribed and to avoid drug-drug interactions patients might not understand or accept.

What do you want pharmacists to accomplish during the phone calls?

Pharmacists can increase patients’ understanding of the therapies they’re taking and ensure everyone—providers and patients—are on the same page as the care moves forward. During the phone calls, pharmacists can identify discrepancies between the medications patients are taking and the medications they should be taking, and communicate issues that arise to the prescribing physicians. That will close the care loop and will hopefully help resolve medication-related problems quickly and effectively.

Why are pharmacists best suited to make the phone calls?

Out of all members of the healthcare team, pharmacists have the best command and knowledge of medications, and can focus on prescribed therapies in ways nurses and even physicians can’t. With that focus, knowledge and education, they’re uniquely qualified to conduct the follow-up phone calls, especially considering how complex medication regimens can be. The practical knowledge they bring to the conversation should also prove beneficial. Interestingly, the pharmacists who will be making the phone calls won’t even be in the hospital, and that’s one of the benefits of this study. We’re going to determine if telephone interventions conducted by pharmacists working remotely can have a beneficial effect on patient care. If they can, we might be able to increase the ability of pharmacists to manage the medication regimens of a greater number of patients in a cost-effective manner.

Will you provide the pharmacists with any guidance of what to discuss with patients?

We didn’t script what they should say, but we do have a standardized set of information we’d like them to obtain during each patient interaction. We’re also instructing the pharmacists to ask each patient to have whatever medications they’re taking—the actual containers and bottles—in front of them so they can read each label to the pharmacists over the phone. That way, the pharmacists will get an accurate account of the medications patients are actually using and compare that information to what’s written on the discharge summary from the hospital. The pharmacists will also be available to answer any medication-related questions patients might have.

Dan Cook