"Meds-in-hand" asthma discharge program a success story

By Megan Brooks

Children hospitalized for asthma who go home with their discharge medications in hand make fewer return trips, clinicians from Boston Medical Center (BMC) have found.

Many pediatric patients don't get their prescriptions filled in a timely manner after being discharged for an asthma exacerbation, which increases the risk for emergency department care and readmission. Recognizing that this was an opportunity to improve care, a team of pediatricians and pharmacists at BMC worked together to develop a discharge medication delivery service called "Meds-in-Hand."

On the day of discharge, medications are delivered to the patient's room, eliminating the need for parents to make a trip to the pharmacy after discharge. In addition, because the medication is delivered by a BMC pharmacist, patients have the opportunity to learn how to use their medications effectively while in the hospital.

After making improvements in the discharge process over two years, the team achieved the project aim of having 75% of pediatric asthma patients discharged with patients with "meds in hand."

Early results also suggest that the initiative has led to a significant reduction in the odds of an ED visit in the 30 days after discharge, compared with patients discharged with usual care (odds ratio, 0.22).

The program was led by Dr. Jonathan Hatoun, formerly of BMC's department of pediatrics, now at Boston Children's Hospital, and Dr. James Moses, a pediatrician and associate chief quality officer at BMC. They and their colleagues describe the program and early results in an report online February 24 in Pediatrics.

"Since the writing of this manuscript, BMC has expanded discharge medication delivery to all pediatric patients and other units of the hospital have implemented similar discharge meds-to-bed services," Dr. Hatoun told Reuters Health by email.

"Certainly other hospitals and admission teams could implement a similar program, though having an on-site pharmacy owned and operated by the hospital was helpful. More importantly, though, we had an excellent partnership between our pharmacy management team and our pediatric inpatient unit. Both parties had agreed that a delivery service was the right thing to do for our patients and agreed to overcome any barriers to make it happen, no matter the cost," he noted.

The meds-in-hand program could also works for other conditions, Dr. Hatoun said.

"We focused on patients with asthma because they are at high risk for re-presentation to care shortly after discharge, so certainly other conditions at risk for readmission would be good targets. There are many more of these in adult medicine, including heart failure and COPD. As hospitals are more and more on the hook for the costs of a re-admission within 30 days, ensuring readiness to leave the hospital should be at the top of an inpatient team's priority list, and we think having medications in-hand is a big part of discharge readiness," Dr. Hatoun said.

The study had no commercial funding and the authors have no disclosures.

SOURCE: http://bit.ly/24pfWgw

Pediatrics 2016.

(c) Copyright Thomson Reuters 2016. Click For Restrictions - http://about.reuters.com/fulllegal.asp