ABSTRACT
OBJECTIVES: Numerous challenges face clinically complex patients as they transition from hospital to home. The purpose of this project was to add pharmacy discharge services to an existing nurse-led discharge service (patient navigation program) to facilitate the transition of care process for clinically complex pediatric patients. METHODS: For select patients referred to the service, a pharmacist resolved medication discrepancies, provided discharge counseling, and conducted follow-up telephone encounters on days 1, 7, and 14 post discharge. Patient demographics, admitting diagnosis, and number of discharge medications were recorded. The impact on patient outcomes was measured by the number and type of pharmacist interventions identified. Program utilization was measured by the number of referrals received, percentage of patients seen by a pharmacist, follow-up phone call completion rate, and pharmacist time required. Financial benefit gained from the program was estimated by translating each pharmaceutical intervention into potential cost savings. RESULTS: There were 321 patient navigation referrals during the 5 months of pharmacist service. A pharmacist was able to provide discharge counseling for 56 discharges (17%). Patients who were provided pharmacy services had a median of 8 comorbidities, 10-day length of stay, and 4 discharge medications. Pharmacists identified 168 interventions, of which 93.5% were accepted or informational in nature. The most frequently identified interventions included clarification of drug order, assistance obtaining medication, and dose rounding. This program resulted in an estimated cost savings of $22,308 in the first 5 months. CONCLUSIONS: A unique partnership between nurses and pharmacists facilitated the discharge process for clinically complex children.
