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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


Pharmacists Do Make House Calls

12/29/2015
As part of a pilot program funded by the Grotta Fund for Senior Care of the Jewish Community Foundation of Greater MetroWest New Jersey, Saint Barnabas Medical Center clinical pharmacist Jessica Bente is making house calls. In collaboration with nurse practitioner Dawn Howard, the pair visits patients that have recently been hospitalized who are at high risk for a readmission.

In one recent house call, a patient was frantic about not having her medications. She reported to Ms. Bente that the hospital had not sent her home with any prescriptions for her blood pressure medications or insulin and that she had nothing left.
 
While Ms. Howard performed a physical assessment of the patient, Ms. Bente was given permission to search the patient’s apartment for medications. All the medications that were found were lined up on a dresser to make it easy to determine what the patient had and what she needed. By doing so, the pharmacist noticed the patient still had three days’ worth of blood pressure medication and insulin.
 
During the physical assessment, the patient’s blood pressure was found to be 190/110mmHg and her blood glucose level was greater than 300—both of which are considered to be extremely high. It was determined in the confusion about the medications that the patient had not yet taken them that day. Jessica instructed the patient to take her blood pressure medication and rapid acting insulin immediately to help get things under control again.
 
The pharmacist also contacted the patient’s home pharmacy to discuss the patient’s most current medications after discharge and the refill status of existing medications. As a result, several discrepancies were identified and resolved.
 
“When I called the patient’s pharmacy, the insulin pens were due to be refilled so I had them refilled and I confirmed that the medications the patient was discharged home with were her current home medications with no changes,” Ms. Bente said.
 
Besides the insulin, it was noticed that all of the patient’s maintenance medications were filled recently. This meant the medications had to be in the apartment somewhere. When asked where the medications could have been stored or misplaced, the patient said she was unsure but that her husband may have packed them away in a box since they were getting ready to move soon. After again obtaining permission, the pharmacist went through the boxes and was able to locate all the medications the patient claimed to have been missing, except one — methylprednisolone dose pack. The patient was supposed to have been discharged from the hospital with this medication but had not been given a prescription for it. Fortunately, the pharmacist was there. She got in touch with the hospitalist and had the methylprednisolone dose pack called in to the patient’s pharmacy.
 
During the visit, Ms. Howard noticed that the patient had “daily affirmations” posted on her wall which led to a conversation about taking charge of her health. “As the patient began to open up, she told us that she used to be very physically active and also involved with her children until she had a heart attack the year prior.  After the heart attack she felt like she was not able to be as active because she was weak, which then led her to gain a significant amount of weight and lose self-esteem,” Ms. Bente said.
 
These factors could have caused the patient to lose interest in taking care of herself and her health. Both the pharmacist and the nurse practitioner then counseled the patient and discussed the healing process and how it can be accomplished with little steps and persistence, and the patient responded positively.  The patient was also counseled on the importance of medication compliance and being her own healthcare advocate.
 
A pillbox was set up for the patient to help her take all her medications on time and as instructed. “I went through how to fill a pillbox and filled the first week for her based on her current medication schedule. We also mailed her a completed MedActionPlan and pocket card for her to fill out her medications and carry in her wallet,” Jessica stated. The MedActionPlan is a list all of her current medications so that she would have an up-to-date list handy when needed. 
 
“During follow-up phone calls after the home visit, the patient would talk about her progress, upcoming appointments and changes in medications before even being asked, and usually we need to dig for those answers,” Ms. Bente stated. “To me, this seemed that she really cared and was proud to be in control.”
 
During this pilot program, Ms. Bente and Ms. Howard from Saint Barnabas Medical Center demonstrated excellent and efficient coordination of care, and it turned out to be a success for the patient. Formal data analysis to determine the impact on readmission rates in ongoing.

 

Working with Quality Insights to Improve Care Coordination and Medication Safety

Quality Insights Quality Innovation Network works with hospitals like Saint Barnabas Medical Center to improve care coordination, medication safety, healthcare quality and more. If you’d like to learn more, contact Nicole Skyer-Brandwene at 732.238.5570, Ext. 2099 or via e-mail at: nskyer-brandwene@hqsi.org. Please also visit the Quality Insights website at:  www.qualityinsights-qin.org.