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Quality improvement endeavors can often feel overwhelming, but chances are, you can learn from the experiences that another physician, hospital or nursing home has had in a similar situation. Coupled with support from Quality Insights Quality Innovation Network, learning what has worked for others — and what didn't — is a valuable strategic planning component. View local stories about the Everyone with Diabetes Counts (EDC) program


Pharmacist Home Visit Fixes Dangerous Medication Error

3/25/2016
Dr. Lipi Soni, a transitional care pharmacist at Trinitas Regional Medical Center in Elizabeth, NJ, has a very special job. She counsels patients on their medications after they are discharged from the hospital, and in some cases, makes a follow-up visit to the patient’s home or meets with them in her office. It is part of a program funded by the Grotta Fund for Senior Care of the Jewish Community Foundation of Greater MetroWest NJ – in collaboration with Holy Redeemer Home Care North and Jewish Family Service of Central NJ – in which patients identified as high risk for readmission receive a home visit from a nurse practitioner and/or a pharmacist after hospital discharge. 
 
A patient was seen by Dr. Soni while in the hospital for a Congestive Heart Failure (CHF) exacerbation. The pharmacist talked to her about the new program and promised to visit her at home after discharge. However, when she tried setting up an appointment, the patient refused because she had a visiting nurse that also saw her regularly. After several attempts, the pharmacist convinced the patient to allow her to visit at home. The patient was a little skeptical at first, but when she saw Dr. Soni and realized she was the same person that had visited her in the hospital, she became more welcoming.
 
During the home visit, Dr. Soni asked the patient to bring out all of her medications so that she could review what each medication was used for, how to take the medication, and any side effects that may occur. “I always start by asking what the patient knows about his/her disease state and about the medicine,” Dr. Soni said. She mentioned the importance of understanding that each patient is different and may require diverse methods of education on these important topics. 
 
“My job is to make sure they understand what is going on and how they can manage themselves better,” Dr. Soni said. “We package this information to suit the patient’s needs and understandings.”
 
Dr. Soni also checked each medication bottle to determine how many pills were left and whether or not the patient was compliant. While doing so, the pharmacist came across a bottle of glipizide (a diabetes medication) which was filled to the top. Upon further inspection, the pharmacist realized the patient had mixed two medications together. She had combined the glipizide in the same bottle with digoxin (a potent heart medication). Instantly, the pharmacist separated the two medications to fix the problem.
 
“I immediately told her not to refill new bottles of medications into older bottles because this is a huge error,” shared Dr. Soni.
 
Had Dr. Soni not caught this error in time, the patient could have experienced a serious adverse drug event which could have led to patient harm and quite possibly a return to the hospital. ”The wife and her husband were very grateful I found the error,” said Dr. Soni.
 
This program exhibits important and effective medication safety and Dr. Soni believes that home visits should be conducted for most patients, especially those at high risk for readmissions. “Patients often think that healthcare is only available at doctors’ offices or hospitals; they don’t think that health care can continue in their homes. It helps them when a healthcare professional comes to their home and demystifies their health,” Dr. Soni explained.
 
“Home visits can also help ensure that the patient is able to manage self-care at home, continue his or her recommended diet that was started in the hospital, as well as take medications safely and compliantly,” Dr. Soni concluded. 
 
“Over the past four years, we developed a team of healthcare professionals and community partnerships that addresses the medical, social and economic issues that contribute to hospital readmissions. This past year, complex medication issues were addressed by adding a pharmacist to the team,” stated Monica Castano, RN, BSN, Interim Administrator/Director of Nursing at Holy Redeemer Home Care North.
 
“Numerous national studies show that the home is the best setting for providing healthcare for older adults – not only is it less expensive, but it is a key to optimal health outcomes. As a funder, we salute Trinitas Regional Medical Center for four years of improvements to care transitions. They have built and utilized strong and broad collaborations among local agencies and, most recently, they have added pharmacists to their home visits,” stated Renie Carniol, Director of the Grotta Fund for Senior Care, an Advisory Council Fund of the Jewish Community Foundation of Greater MetroWest NJ. The Grotta Fund is committed to supporting evidence-based programs that improve the quality of life of older adults living in Essex, Union, Morris, Sussex and eastern Somerset counties in NJ.