Measuring the impact of a pharmacist-led order entry vs standard of care for 9 skilled nursing facilities across western and central New York

Suwanee, GA

Introduction

Medication reconciliation is the process employed to reduce the frequency of adverse drug events for patients during the hospital discharge. It’s estimated that 35-45% of adverse drug events (ADE) arise from medication errors typically identified in the medication reconciliation process, leading to increased cost on the healthcare system and practitioners. This research aims to identify whether the practitioner, either pharmacist or nurse, completing medication reconciliation conveys a statistically significant reduction in the number of 30-hospital readmissions due to preventable medication error.

Methods

A comprehensive chart review was completed spanning dates 1/1/2022-1/1/2023 comprising the nursing-led cohort, and 7/1/2023-7/1/2024 comprising the pharmacist-led cohort. All ED/hospital transfers received a thorough chart review looking for possibly preventable 30-day readmissions related to medications. Possible errors included inadequate monitoring plan, omission, inappropriate dose (e.g. for indication of renal function), lack of bowel regimen when initiated on an opioid, adverse drug events, inappropriate administration of medication on the Beer’s list/polypharmacy, and other features clinically assessed during the pharmacist’s review.

Results

Data demonstrated an absolute risk reduction of 9.17% in the pharmacy group compared to nursing, with a number needed to treat of 10.9 indicating that a pharmacist-led medication reconciliation process would prevent one 30-day hospital readmission every 11 patients with a post-hoc power analysis of 99.7%.

Discussion

These results indicate a benefit to transitioning from a nursing-led medication reconciliation to pharmacist-led process, saving both time needed for assessment in ED, cost to nursing facilities and hospitals. Centers for Medicare and Medicaid Services withholds Medicare payments for both the facility and the hospital on all 30-day readmissions, impacting the resources available to nursing facilities. We are currently working on a quality initiative with our local hospital systems incorporating this program to help reduce 30-day readmissions. In addition to impacting 30-day readmissions, the pharmacist works with the provider to ensure that the resident is on an appropriate dose for renal/hepatic function, indication, and history of present illness, appropriate formulation (considering the need to crush medication due to dysphagia, preference, or feeding tube), duration of therapy, resident-specific indication, and monitoring plan for safe use during the resident stay.