Implementation of transitions-of-care services through acute care and outpatient pharmacy collaboration
Implementation of transitions-of-care services through acute care and outpatient pharmacy collaboration
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DOI：
10.2146/ajhp140504
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发表时间：
2015-05-01
影响因子：
2.7
通讯作者：
Swarthout, Meghan
中科院分区：
文献类型：
--
作者：
Gilmore, Vi;Efird, Leigh;Swarthout, Meghan
目的。描述了一种实践模式的实施，该模式旨在通过优化药房人员在多学科护理协作团队中的部署来减少医院的阅读任务。为了响应《平价医疗法案》旨在减少可预防的再次住院的条款，约翰霍普金斯医院(JHH)的药剂部牵头实施了一种跨越住院和门诊设置的新药房服务模式。该模式的关键组成部分包括：(1)药剂师更多地参与多学科查房，(2)有针对性的药物协调和患者教育，(3)对选定患者的出院后电话监测，以及(4)由“过渡药剂师延伸员”执行的床边出院用药：将护理协调活动纳入日常工作流程，提高了患者对高风险药物的教育比率，并允许在患者出院前设计负担得起的有效用药方案和配药。最终目标是加强多学科合作，通过提高服药依从性和患者对药物的理解来减少再次住院。JHH的住院和门诊药房团队合作，通过有针对性的药物调节，在入院期间对患者进行高风险药物的教育，以及开发患者出院时将手持的负担得起的实用药物方案，提高他们对患者入院前用药的了解。开发了一个药房团队模式，以确保充分提供这些服务，并加强患者对药物对急慢性疾病状态管理的重要性的理解。
Purpose. The implementation of a practice model designed to reduce hospital read-missions through optimal deployment of pharmacy staff on multidisciplinary care collaboration teams is described.Summary. In response to Affordable Care Act provisions aimed at reducing preventable hospital readmissions, the pharmacy department at The Johns Hopkins Hospital (JHH) led the implementation of a new pharmacy services model spanning both inpatient and outpatient settings. Key components of the model include (1) increased pharmacist participation in multidisciplinary rounds, (2) targeted medication reconciliation and patient education, (3) post-discharge phone monitoring of selected patients, and (4) bedside discharge medication delivery performed by a "transitions pharmacist extender:' Incorporation of care coordination activities into the daily work-flow has increased the rate of patient education on high-risk medications and allowed for affordable and effective medication regimens to be designed and prescriptions to be filled prior to patient discharge. The ultimate goal is enhanced multidisciplinary collaboration to decrease hospital readmissions by increasing medication adherence and patients' understanding of medications.Conclusion. The inpatient and outpatient pharmacy teams at JHH collaborated to improve their understanding of patients' medication use prior to admission through targeted medication reconciliation, education of patients on high-risk medications initiated during admission, and development of affordable and practical medication regimens that patients would receive in hand on discharge. A pharmacy team model was developed to ensure that these services are adequately provided and enhance patient understanding of the importance of medications for acute and chronic disease state management.