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How Pharmacists Improve Medication Management at Transitions of Care

ways to increase medication compliance

Transitions of care — defined by the Centers for Medicare & Medicaid Services (CMS) as "The movement of a patient from one setting of care to another" — have been identified as a significant vulnerability in our healthcare system. Why? As the Agency for Healthcare Research and Quality (AHRQ) notes:

  • transitions increase the risk of adverse events due to the potential for miscommunication as responsibility is given to new parties;
  • hospital discharge is a complex process representing a time of significant vulnerability for patients; and
  • safe and effective transfer of responsibility for a patient's medical care relies on effective provider communication with patient comprehension of discharge instructions.

In fact, these challenges are so great — and the opportunities to improve them so significant — that better implementing and providing transitions of care among healthcare settings have been identified as "an important target for the Triple Aim of improving care quality and the patient care experience, improving the health of our population, and reducing cost," according to an article in the AMA Journal of Ethics.

For organizations looking to strengthen how they approach transitions of care, one area they should focus on is medication management. Medication management, as we note in our guide on the subject, is a service designed to help patients manage their medications so they take them as prescribed and avoid the adverse effects associated with incorrect medication administration. With approximately 50% of patients taking medications incorrectly, improving medication management at transitions of care will help improve outcomes, reduce patient harm and deaths, and decrease costs, readmissions, and readmission penalties.

And there may be no one better suited to help organizations achieve such improvements than pharmacists.

5 Reasons Pharmacists Improve Medication Management at Care Transitions

Here are five of the reasons why pharmacists can help organizations with medication management at transitions of care.

1. Medication expertise

Pharmacists are a better suited for med rec because we have the time and are more familiar with navigating through the med rec process with unreliable sources, etc. to get the most complete and accurate med list from the patient and caretakers. A column on SafeMedication.com, a resource developed by the American Society of Health-System Pharmacists (ASHP), summarizes a pharmacist's education and how they develop and maintain their extensive medication expertise. While pharmacists are more than just drug experts, their typically unmatched medication knowledge makes the pharmacist role in transitions of care tremendously important for this reason alone.

2. Trustworthiness

Pharmacists are viewed by the public as highly ethical and honest. Based upon Gallup's most recent "honesty and ethics survey" of Americans, conducted December 1-16, 2021, pharmacists' honesty and ethics rating trailed only nurses, medical doctors, and grade-school teachers. The U.S. Census Bureau calls attention to this impressive rating on its page dedicated to National Pharmacist Day, with the bureau noting this public esteem is "A good thing, as 7 out of 10 Americans take at least one prescription drug."

Such credibility is important. When combined with their medication expertise, pharmacists are more likely to provide accurate and beneficial medication-related guidance during transitions of care that should also be trusted and thus properly acted upon by patients and healthcare team members.

A Journal of the American Pharmacists Association's article on preventing medication errors in transitions of care notes, "Pharmacists can conduct numerous interventions to prevent medication errors during transitions of care and ensure patient safety. Pharmacists are integral to evaluating the appropriateness of medication use, ensuring information is updated in the health record, and verbally communicating accurate information to other health professionals."

3. Access to medication information

Coordinating care transitions is identified by the American Pharmacists Association (APhA) as one of the eight essential medication-related responsibilities for pharmacists linked to improving patient safety. One of the reasons why, as APhA notes: "Pharmacists are often the only member of the healthcare team with access to the patient's complete medication list. As a result, they are uniquely positioned in the healthcare system to impact patient safety by managing care transitions."

4. Proper completion of medication reconciliation

Now let's discuss one of the most important facets of transitions of care: medication reconciliation. Transition of care success — specifically those transitions in which new medications are ordered or existing orders are rewritten — is dependent upon appropriate completion of med rec. It has long been understood that hospitalized patients experience frequent medication errors, with such errors representing one of the most common types of patient safety errors. Medication reconciliation during transitions of care is essential for ensuring a patient's medication list is accurate and does not include discrepancies or omissions that could lead to an adverse drug event. The Institute for Healthcare Improvement calls attention to the importance of medication reconciliation during transitions of care, stating, "Many organizations have demonstrated that implementing medication reconciliation at all transitions in care — at admission, transfer, and discharge — is an effective strategy for preventing ADEs.

Pharmacists are in the best position to complete medication reconciliation during transitions of care in the more efficient and effective manner. In an AHRQ Patient Safety Primer on the pharmacist's role in medication safety, the agency highlights the value of a pharmacist taking the lead on medication reconciliation as part of the effort to coordinate medication management across care transitions, noting, "Pharmacist-led medication reconciliation may identify potential interactions or omissions from medication list at transitions in care, which are prone to error."

In this blog post, we identified putting pharmacists in charge of medication reconciliation as a best practice to improve medication reconciliation, noting that "Various studies show that medication list accuracy increases and adverse drug events decrease when pharmacists — sometimes supported by registered nurses — manage the reconciliation at each transition point." Furthermore, physicians we interviewed whose health systems have employed pharmacists and pharmacy techs to conduct med rec said that their medication reconciliation accuracy has improved."

5. Consistent performance of medication reconciliation post-discharge (MRP)

One of the most important types of medication reconciliation is the med rec that's performed when patients transition out of an acute care organization following a period of hospitalization: medication reconciliation post-discharge (MRP). As we highlight, there are 36 million discharges annually but 40-50% do not have MRPs performed. Such a high rate is contributing to the millions of patients who experience an adverse drug reaction post-discharge and the millions who need to be readmitted due to such reactions.

Performing an MRP at every discharge is vital for several reasons, including:

  • It reduces patient risk and improves outcomes.
  • It reduces readmissions and thus decreases readmission penalties — challenges for many hospitals.
  • It improves patient satisfaction.
  • MRP and medication reconciliation have their own CMS and HEDIS quality measures.

We are starting to see just how valuable of a role pharmacists can play when they are responsible for performing MRPs. Cureatr has been performing random controlled trials with clients. Speaking about one such trial, Cureatr Chief Executive Officer Richard Resnick states, "At a 4-star hospital system we support, a random controlled study has shown us to provide a 56.5% reduction in 30-day readmissions for congestive heart failure patients that receive our MRP service. In other words, the patients in the control group — those who do not receive our service — are readmitted at a certain rate and our patients are 56.5% less likely to be readmitted within 30 days. This reduction in readmission rates is unheard of…"

Taking Medication Management During Transitions of Care to a Higher Level

Effective medication management during transitions of care is critical to improving patient care, increasing staff satisfaction and decreasing staff burnout, reducing costs, and helping organizations avoid penalties. At Cureatr, we combine clinical pharmacy experts, advanced technology, and comprehensive data in our efforts to support organizations looking to improve their transitions of care and help solve the medication management puzzle that has long strained our healthcare system. Learn about our clinical service and the challenges we solve, schedule a time to speak with one of our consultants.

Resolve Issues with Medication Reconciliation - Ebook


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