Pharmacists played a critical role in helping a hospital to earn their designation as a certified primary stroke center. A certified primary stroke center, or a “PSC” is a certification designated by the dual efforts of the American Heart Association and American Stroke Association. A PSC certification for a hospital means better care for stroke patients, and can increase patient confidence in the hospital and recruit more talented healthcare professionals. In 2010, New Hanover Regional Medical Center (NHRMC) in North Carolina saw the opportunity to improve their stroke care and gain their certification and help treat more patients in an area that has higher rates of stroke mortality than any other region in America. In order to gain this certification, they made a “Code Stroke” multidisciplinary response team that included the pharmacy director and created a position for a direct patient care pharmacist. The Code Stroke team reviewed outcomes data and oversaw the creation and operations of stroke procedures. This included streamlining the care of stroke patients, from admission to discharge.
A critical element of this streamlined process was the role of the pharmacist. Pharmacists were assigned to the emergency department, ICU, progressive care unit, and outpatient pharmacy that serves to discharged patients. All the different pharmacy units used the same computerized-prescriber-order-entry system, that allowed for consultations, monitoring, chart reviews, and notification about discharges. This integration between the pharmacists was aimed at reducing dosing errors, preventing incorrect administration of alteplase, and decreasing the amount of time it takes to administer alteplase to a stroke patient. Since there is an emergency room pharmacist, they can be one of the first healthcare professionals to correctly assess the medication needed for the patient. Also, the program instituted a 24-hour emergency department pharmacist, makes sure that all pharmacists on emergency department rotations are up to date on Code Stroke duties. Ultimately, NHRMC did obtain the certification, thanks largely in part to the pharmacy unit. I think that this article shows the importance of pharmacists in clinical settings, and how pharmacists across different units of a hospital can improve care when there is adequate communication and transitions of care. By reducing medication errors and improving patient outcomes, I think that the role of the pharmacist in clinical settings will only continue to increase.
Reference: Gilmer A, Sweeney L, and Nakajia S. Pharmacists’ role in a hospital’s initiative to become a certified primary stroke center. Am J Health Syst Pharm. 2016. 73 (Supplement 1):S1-S7.
Transitional care refers to the process of continuing health care treatment between the time in which the patient is moved from one healthcare setting to another. Recent studies have shown that implementation of transitional care practices can aid in the reduction or readmission rates for patients with a chronic disease state; however, there has not been information analyzing the utilization of transitional care in patients with a mental illness. For this reason, researchers from North Carolina aimed to look deeper into the effects that transitional care can have by focusing on a population of Medicaid patients who had both a mental illness and a chronic disease state.
In this study, researchers analyzed the effects that transitional care had on the population by monitoring hospital discharges and readmissions over the course of a year. A total of 1,717 Medicaid patients met the criteria for the study and of this number 1,104 patients were provided with a transitional care assessment or intervention. The data collected from the study showed that patients receiving transitional care after a hospitalization for a non-psyciatric reason were much less likely to be readmitted 30 days after discharge (18% compared 27%). This gap between the readmission rates of the two groups continued to have a level of significance throughout the year. The same results were found to be true regarding patients who had initially been admitted to the hospital for a psychiatric reason.
I believe this study is important to understanding the role that healthcare professionals can have in affecting the health of a patient. The time that we give to provide personalized education to patients experiencing multiple chronic conditions can have a huge effect on the patients future health. This is something that is also beneficial to our nation’s healthcare system which experiences heavy costs in relation to improper management of a patient’s health after the time of discharge. I would like to know more about how transitional care is currently being utilized in the inpatient and outpatient setting so that I can further improve my patient care skills.
Around 60% of all medication errors happen during transitions between health care settings. These errors can lead to adverse effects and readmission into hospitals. Having a pharmacist present during these transitions to educate patients on their medications and to talk to the patient to make sure that they can afford all of their medications can decrease the rate of readmissions to hospitals and improve adherence. This study was done at a hospital in Arizona that had previously only had physicians or nurses talking to patients during the transition-of-care period. The pharmacist not only educated patients, but also fixed medication errors such as duplications in therapy, incorrect doses, and inappropriate prescriptions, which were found with nearly half of the patients leaving the hospital.
The addition of a pharmacist in this setting improved the hospitals’ readmission rate by a statistically significant amount. This shows the importance of pharmacists in a hospital setting, and also shows that pharmacists are currently being underused. Pharmacists are the health care professionals that know the most about medications, so it makes sense that they should be involved when patients are leaving hospitals with new medications. This study has shown the benefits of having a pharmacist playing a more active role in health care, specifically in transitions of care. Hopefully this will lead to a greater recognition of this facts and we will see more pharmacists in the transition of care setting.
Balling, Lauren, Erstad, Brian L., and Weibel, Kurt. “Impact of a transition-of-care pharmacist during hospital discharge.” Journal of the American Pharmacists Association 55.4 (2015): 443-448. Sciencedirect. Web. < http://www.sciencedirect.com.pitt.idm.oclc.org/science/journal/15443191/55/4>