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Nine Habits of Building a Successful Discharge Medication Education Service
In my days as a geriatrics pharmacy resident, I spent most of my time providing clinical services on a geriatric rehabilitation unit, including discharge medication education. So, it seemed logical that the first clinical pharmacy service I should implement when I started at Guthrie County Hospital, Iowa, would be discharge medication education. For those of you considering or currently implementing a discharge medication education program, read on for a few ideas and lessons learned.
- Gain administrative support. Like many rural hospital pharmacists, I report to the hospital’s administrator. I didn’t ask permission to provide discharge medication education; I consider it my responsibility as a pharmacist to provide education to patients about their medications. However, I did inform the hospital administrator of my plan and that I would be coordinating my efforts with the nursing staff. Make sure that your hospital administrator understands that you, as the medication expert, should be providing medication education whenever possible. You won’t be reimbursed for your education to inpatients, but sharing your knowledge certainly enhances patient care. Discuss placing a question on the hospital’s inpatient satisfaction survey pertaining to the opportunity to discussing medications with a pharmacist. Your administrator will be sold on your educational efforts when the patient satisfaction surveys come back positive.
- Gain nursing support. Remember that, historically, nursing staff has taken ownership of the discharge education process, including discharge medication education. Nursing staff needs to understand and contribute to your plan to provide discharge medication education, as this will be a change in their process. My experience has been that the nurses’ response was positive; in fact, they seemed to be happy to turn the responsibility of medication education over to a pharmacist. However, don’t be surprised if you receive a mixed reaction, as some nurses may feel that this is encroaching on their territory.
- Decide how will you target your medication education efforts. Decide if you will provide discharge medication education to all patients or use criteria to determine which patients will benefit most from your time and knowledge (based on number of medications, complexity of the regimen, specific disease states or high-risk medications, etc.). My goal is to provide education to all patients being discharged, with the exception of patients who are either being admitted or are returning to a long-term care facility. Since the vast majority of rural hospitals operate without 24-hour pharmacy services, you will also need to think about how discharge medication education will be provided when a pharmacist is not on site.
- Choose the right implementation tools. Do you plan to incorporate written educational materials or demonstration products into your verbal education? Pharmaceutical representatives are great sources of free written information, placebo metered-dose inhalers and injection demonstration kits, just to name a few. Also consider what the patient might need in terms of helping them to adhere to their medication regimen at home, such as medication organizers ("pill boxes"). I approached our hospital’s charitable foundation board with a request to purchase pill boxes of different sizes (one dose per day, two doses per day, four doses per day) to give to patients for free in an effort to improve medication adherence. The hospital’s logo is printed on each organizer with the statement "Provided by the Guthrie County Hospital Foundation," so it is good promotion for the hospital and the foundation. We purchase them in bulk so that we get the best price. It has proven to be a very successful program.
- Know the discharge destination. It is important to know the patients’ discharge plans ahead of time whenever possible. Some possible discharge destinations include going home independently, going home with family or other caregiver support, going home with public health nursing services or moving to a long-term care facility. Knowing the discharge plan will help you determine who needs to be present during your medication education session. For example, if the patient is going home and the adult child will be managing the medications, the adult child should be available to ask questions. Another reason to be aware of the patient’s discharge plan is to prepare for the patient’s medication-related needs at home. For example, patients newly diagnosed with diabetes will not only need education regarding their new medications, but will probably also need your assistance in obtaining a glucometer and supplies. The ideal forum for receiving discharge information is interdisciplinary care planning meetings where discharge planning is coordinated. If your pharmacist staff is not already attending these meetings with other healthcare professionals, I strongly suggest you consider it.
- Coordinate with the discharging physician. One of the many advantages to practicing in a small hospital is the familiarity and availability of the pharmacy and medical staff. Whenever possible, try to communicate with the discharging healthcare provider while he or she is writing discharge medication orders or during rounds to be sure that you understand the intentions for the discharge medication regimen. I find that the most effective method for accomplishing this is to review the admission medication history with the physician and ask which medications are to be continued and if there are any to be discontinued. I then go through new medications and dosing changes and obtain written prescriptions for those. If you will be sending a discharge medication list home with the patient, it is a great idea to have the physician review it with you. Getting your questions regarding the discharge medication regimen before the education session will prevent frustration both for you and for the patient who is likely to be in a rush to get out the hospital door.
- Coordinate the discharge with nursing. Work out a system between nursing and pharmacy staff to make the discharge as efficient as possible. Remember that medication education is only one component of the discharge process and so you will need to coordinate with nursing, and possibly other disciplines, to assure that you are all able to complete your "piece" of the discharge. Regardless of the coordination system you come up with, it should involve notifying the pharmacy as soon as possible once it is decided which patients are being discharged and, if known, what time.
- Communicate the discharge medication regimen. Obviously, it is important that the patient have a copy of his or her discharge medication regimen. I am sometimes responsible for preparing the discharge medication list for those patients whose regimen is particularly complex. I always am sure to place a copy in the chart and I send one copy to the discharging physician’s clinic, in addition to a copy for the patient. I also provide a copy to the public health nursing staff if the patient will be followed by them.
- Document, document, document. We all know the saying: "If it isn’t documented, it didn’t happen." Be sure to chart your education with the patient and/or anyone else who was present, in addition to the discharge medication list. You should also document the points you stressed about each medication including possible drug interactions and adverse reactions, time of day to take the medications, storage conditions, etc. Document your assessment of the patients’ and/or caregivers’ understanding. Your hospital probably already has a discharge instruction form for documentation; take a look at it and see if it will meet your needs for documenting medication education.
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