Care Transition
Conditions
Keywords
Care Transition, Medication-Related Problems, Post-Acute Care, Skilled Nursing Facility, Hospital Systems, Medication Safety
Brief summary
The Pharmacy Integrated Transitions (PIT) program, utilizes a crossover randomized control design to evaluate the impact of a clinical pharmacist in decreasing medication related problems during a patient's transition from hospital to skilled nursing facility (SNF).
Detailed description
Standard hospital discharge processes (e.g. as recommended by the Joint Commission Center for Transforming Healthcare), include hospital staff completing a paper-based discharge summary and medication reconciliation form. To reduce the likelihood of medication-related problems during care transitions, the Pharmacy Integrated Transitions (PIT) program aims to improve the standard transition process by adding a coordinating transitional pharmacist to provide a structured synchronous warm-handoff between clinical teams at the hospital and the Skilled Nursing Facility, in addition to reconciling, adjusting, and monitoring medications during and after discharge from the hospital.
Interventions
OTHERStructured hand-off
Use of standardized checklist to provide synchronous or asynchronous handoff that conveys medication recommendations to the SNF clinical teams
OTHERMedication reconciliation during transitional period
Comprehensive medication reconciliation conducted during transitional period between hospital and SNF, focused on SNF-specific requirements for medication delivery (e.g., stop dates, titration instructions)
OTHERTransitional medication monitoring
Review of medication orders during first 7 days of SNF admittance to address barriers to translation of medication orders and appropriate medication delivery
OTHERTeleconsultation
Ad hoc consultation to provide additional clarification to SNF clinical teams
Sponsors
Agency for Healthcare Research and Quality (AHRQ)
University of Washington
Study design
Allocation
RANDOMIZED
Intervention model
CROSSOVER
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Intervention model description
A parallel cluster-randomized controlled crossover trial design, with randomization occurring at the skilled nursing facility cluster level. The trial is conducted across four hospitals and 14 independent SNFs in Washington State. SNF's are stratified by patient volume before randomly assigned to either the PIT program or usual care.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* 18 years of age and older * patients receiving inpatient care at University of Washington Mountlake, University of Washington Northwest, Harborview, and Valley Medical Center hospitals to one of 14 collaborating SNF's on a day when the PIT program pharmacist is conducting the intervention
Exclusion criteria
* Under 18 years of age * patients with a discharge on hospice care * patients discharged on days that the pharmacist is not conducting the intervention
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Medication Related Problems | 30 days post hospital discharge | Number of medication related problems experienced by patients within 30 days post hospital discharge. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Death | 30 Days post hospital discharge | Number of deaths experienced by patients within each cohort |
| Readmissions | 30 Days | Number of readmissions within 30 days of index hospital discharge |
Countries
United States
Outcome results
None listed