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The Truven Health Blog


The latest healthcare topics from a trusted, proven, and unbiased source.


Need More Evidence that Patient Education Can Reduce Readmissions? Start Here.


By Arti Bhavsar/Tuesday, August 26, 2014
Arti Bhavsar imageAs healthcare practitioners and administrators, we are keenly aware of the complexities associated with preventing readmissions. Common questions that come to mind when tackling the readmissions dilemma include: What patient care and education interventions can we implement? Do we have a solid transition of care program? What is the cost impact to my organization, from direct costs to loss in reimbursement? Most importantly, how can we embed sustainable programs to avoid readmissions? 

Take for example the impact of medication management related issues as a factor for readmissions. In an evaluation conducted by Feignbaum, et al. at Kaiser Permanente, researchers studied factors contributing to readmissions within 18 hospitals (1).  Medication management issues impacted 28 percent of preventable readmissions and were identified as one of the top five areas for to prioritize for organizational intervention programs. Upon interviewing 189 patients and caregivers, researchers found that 32 percent of patients indicated they would have liked to have received more communication regarding their medications, and of these, 73 percent of caregivers indicated that lack of information was one of the components that lead to a readmission (1). This data, coupled with a recently published article by Mixon, et al. focusing on post-discharge medication errors, highlights a significant area of opportunity to prevent medication management related issues. The study indicates that medication errors ranging from omissions, commissions, and misunderstanding in indication, dose, and frequency were found in 50 percent of patients after hospital discharge (2). The groups most impacted were those with low health literacy and numeracy scores (2). These statistics are sobering and should make us want to re-evaluate our current approach towards medication-related patient education in order to improve our practices to reduce the risk for patient harm and eliminate avoidable readmissions. 

When creating a strategic approach to reduce medication management related readmissions and errors, organizations should consider the following areas of improvement:
  • Integrate medication handouts into Electronic Health Records (EHR) to optimize clinician work flow and enhance the patient discharge process
  • Provide patient education handouts that adhere to health literacy standards to improve patient comprehension and retention of medication management related topics with tools designed for those with greatest risk of non-compliance (low health literacy and numeracy)
  • Embed a “Teach-back Process” to validate patient and/or caregiver comprehension of the medication management related information provided
  • Provide low-literacy aids to augment learning with tools such as pill-boxes, text messages, and/or daily medication schedules
These interventions are not only meaningful for the clinical outcome improvement results they can provide, but they are also aligned with safety, regulatory standards, and compliance standards that lead to higher reimbursement payments. These incented standards range from reduction in readmissions related to medication management events, to attestation for Meaningful Use Stage II criteria for integrated patient education and improving patient satisfaction scores as evaluated by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. 

Pharmacists, physicians and nurses, it’s time to ask yourself how your organization is approaching medication-related patient education. Has your organization mobilized the medication-related experts who impact care decisions at the point of care? Do you have the opportunity to improve your work flow to make time for caregivers to exercise best practices in education on discharge? Do you know how many patients you are discharging with medication errors? These questions can help you on the journey to reduce your medication management related risk and improve your organizational approach.

Arti Bhavsar, Pharm.D.
Consulting Manager

Pediatric Emergency Department Quality of Care: A Focus on Pharmacists and Drug Therapy


By Linda Elbers/Wednesday, July 23, 2014
Linda Elbers imageListening to National Public Radio (NPR) on the way to work recently, I heard a very interesting report about Children’s Medical Center in Dallas incorporating full-time emergency department (ED) pharmacists to ensure appropriate and optimal drug therapy is provided to their patients in the ED setting. As a pediatric-trained pharmacist, anytime I hear about organizations embracing the pharmacists’ role in doing even more to support safe and effective drug therapy in this patient population, it’s particularly exciting. And this information was timely, as my colleague Tina Moen, Chief Clinical Officer for Truven Health, just shared her thoughts about the expanding role of the pharmacist in a recent blog post. While pharmacists have known for some time that we have a great deal to contribute to improving patient safety, it’s wonderful to know that others are taking notice now more than ever.

Important, key organizations such as the American Academy of Pediatrics (AAP) and Emergency Medical Services for Children (EMSC) are focusing much time and effort on improving pediatric services in U.S. emergency departments. This isn’t just for pediatric-specific emergency departments, but for any ED that will see neonatal and/or pediatric patients, whether frequently or infrequently. It’s estimated that up to 25 percent of all ED visits in the U.S. are pediatric patients, and approximately 90 percent of children’s visits to the ED are in non-pediatric hospitals.

EMSC – an organization that works to promote emergency medical services (EMS) and trauma system development at the local, state, regional, and national levels to adequately prepare for care of children – has developed 60 ED pediatric performance measures that comprehensively cover a broad range of assessable activities related to pediatric emergency care. I recommend visiting www.emscnrc.org to learn more about this resource.

As you would expect, some of the 60 EMSC performance measures and their potential outcomes are associated with drug therapy. For example, “timely treatment with anti-epileptic drugs for patients in status epilepticus” is one of the performance measures. The numerator for this performance measure is the number of patients who received an anti-epileptic drug within 10 minutes of arrival, and the required data elements include medication name, patient arrival time, and medication receipt time. As a pharmacist, however, there are many additional steps in this arena to further care and improve outcomes, simply by applying a medication-focused lens. For instance, while the patient may receive an anti-epileptic medication within 10 minutes of arrival, to assess the efficacy of the therapy, we need to know additional information and should do further assessment, including asking:
  • Did the medication provided actually resolve the seizure?
  • Was the right drug administered for this patient?
  • Was the correct dose prescribed?
  • What resource was used to determine the dose? How was it calculated?
  • Was it administered correctly?
Without this further evaluation of medication practice, it’s difficult to affect outcomes and quality.

Other EMSC performance measures address pain management and sedation (e.g., the effective pediatric procedural sedation, treating and reassessing pain). While there are criteria for assessing adequate sedation or adequate pain relief, again, as a pharmacist, it’s clear that more information would lead to marked advancement in patient care. For example, if there were additional documentation required regarding the drug(s) used, the dose(s) used, the route of administration, etc., this would help to assess outcomes. As such, the additional detail can assist in developing protocols to assure adequate sedation or pain control in the majority of situations – a problem patients across the country routine indicate is an area of patient dissatisfaction in HCAHPS results each year. And this additional detail could identify inconsistencies or inadequate drug therapy, including drug dosing that leads to inadequate/ineffective sedation or pain control.

As the NPR story pointed out, not all hospitals will have the resources to hire a full-time, or even a part-time, ED pharmacist to manage pediatric drug therapy in the ED setting. However, a pharmacist’s focus and input have the potential to contribute greatly to improved pediatric emergency care. What has your ED done to be better prepared to treat children? How are pharmacists contributing to better emergency care? Let us know what first steps you have taken, or would like to take, to help your organization and others meet the mark for pediatric and neonatal care in the ED.

Contact me on LinkedIn.

Linda Elbers, Pharm.D.
Clinical Solution Advisor Neonatal/Pediatric Evidence-Based Practice

The Expanding Role of Pharmacists: Out of the Basement and Into the Spotlight


By Tina Moen/Wednesday, June 18, 2014
Tina Moen imageWhat does it mean to be a pharmacist in 2014? I recently presented at the Health Connect Partners Spring Pharmacy Conference to a room full of pharmacy leaders from across the country. We discussed the evolution of the practice of pharmacy, the things we have seen change over the years, and the opportunities (and challenges) we see on the horizon. Throughout the conference, many attendees shared stories of how their responsibilities as a pharmacist have evolved throughout their careers. Our conclusion is that now – more than ever – there are visible, meaningful changes to our role as it relates to patient care, collaboration with our peers, and in leadership participation in the healthcare community.

Clinical pharmacy services, as we know it, are a result of continuous evolution of the historical pharmacy role – namely dispensing medications from behind the counter or in the basement. This evolution has taken many years. Pharmacists now deliver enhanced value to their organizations and their patients with a focus on quality, safety, and efficacy of medication therapies. Programs such as enhanced Medication Therapy Management continue to highlight the impact pharmacists can make on reducing adverse effects and improving efficacy of a patient’s medication regimen. Additionally, pharmacists contributing to Medication Reconciliation and specialty services, like Anticoagulation or Diabetes Clinics, continue to demonstrate that rounding out the care team to include a medication specialist improves patient outcomes and enhances the practice and performance of clinical peers. And recently, I have seen emerging cross-functional leadership teams working toward goals such as the IHI “Triple AIM,” begin to include Pharmacy; tying personal goals and incentives for DOPs to these efficiency and quality objectives.

Clearly, great progress has been made in the practice of pharmacy, and I for one am proud of the role pharmacists play in enhancing the patient experience and outcomes. So, what's next? Here are the things that come to mind when I ask myself this question.

Healthcare IT
A recent article in Healthcare IT News advocated for pharmacists playing a larger role in EHR strategy. As a pharmacist who works within the healthcare IT industry, I couldn’t agree more. What percentage of patients in a hospital has at least ONE medication order? I would venture to say “most.” It’s an obvious conclusion that the profession charged with the safe and effective use of medications should have a significant role in the development, selection, and implementation of tools used to properly care for those patients. And then there is Meaningful Use. How many of the Meaningful Use Objectives are related to medications and the services in which pharmacists participate? Who better then to take the lead in organizational efforts for Stage II attestation and Stage III planning?

Care Collaboration
Cross-departmental coordination for initiatives that span hospital leadership continues to grow in scope and importance. Benefits of pharmacists as integral members of rounding teams within the inpatient setting are well-documented. With organizations designing and implementing Population Health and ACO strategies, pharmacy leaders can capitalize on the combination of data analytics and clinical insight that are the hallmarks of pharmacy practice. As Population Health initiatives evolve – who better than a pharmacist to guide trends in medication recommendations in treating high-risk conditions and ensuring safe, cost-conscious practice remains top of mind?

Quality Patient Care
Providing quality patient care has always been a focus of healthcare providers. Today’s environment adds a variety of incentives and penalties to drive quality. How are pharmacists contributing? In many ways! Pharmacists are well-suited to lead the charge on initiatives like Antimicrobial Stewardship, a quality and a cost management initiative. The importance of medication education and adherence in the improvement of HCAHPS scores and the reduction of readmissions are additional examples how pharmacists can and should use their skills as medication specialists to drive improved patient care. Because results summaries from nation-wide HCAHPS surveys indicate that Medication Safety and Pain Management questions are still amongst the lowest performing areas – shouldn’t pharmacists’ input at the patient care level be paramount?

As I said during my visit to Health Connect Partners, it’s good to look back occasionally to see the progress that has been made and to help motivate us for the challenges and opportunities ahead of us. What is next? What have I missed? I would love to hear from my fellow pharmacists on where the practice of pharmacy will be in the next 10 years. What are you doing today to move the needle in the evolution of pharmacy?

Tina Moen, PharmD
Chief Clinical Officer

How Hospital Pharmacy Can Integrate Technology to Impact HCAHPS Scores


By Tina Moen/Friday, September 27, 2013
Tina Moen imageQuality care and finance. The balance of these essential elements holds the key to the future of how we provide healthcare. Multidisciplinary care is more important than ever in caring for patients, and looking at the whole picture is the best way to care for the whole patient. The Centers for Medicaid and Medicare Services (CMS) agrees. How your hospital scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is becoming increasingly important, especially since under the CMS Value Based Purchasing (VBP) program,
reimbursements are partially based on those scores.

How can pharmacists use their expertise to impact patient satisfaction and boost HCAHPS scores?

HCAHPS wants to know, if during the hospital stay, did the patient receive new medication? If so, how often did staff tell the patient what the medicine was for, and did staff describe possible side effects in simplified terms?

Pharmacists can directly impact these questions by combining clinical expertise with technology. We can make every reasonable effort to:
  • Explain to our patients why they are taking new medications – when prescribed, at first dose, and at discharge.
  • Use clear wording to help patients understand why they are taking a medication and what they can possibly expect as a result.
  • Give them patient-specific medication handouts and discharge instructions.
  • Make ourselves available to patients and to staff, to answer medication related questions.
And with technology, we can ensure we are educating our patients by scaling our efforts and making our available manpower more efficient. One of our clients, Arkansas Methodist Medical Center, is using Micromedex® Pharmacy Intervention to set alerts to remind their clinical pharmacists which patients are on new medications, develop protocols with simplified terminology for all pharmacists to follow uniformly, and then track their progress. View the video to see how they are making this work for them.

As pharmacists, we can also leverage Micromedex clinical decision support, embedded within the Pharmacy Intervention solution, or accessible via the 2.0 platform, to access the talking points within the Clinical Teaching section. Clinical Teaching highlights the most pertinent medication information and serves to inform clinicians on what patients need to know about medication use, safety, and side effects.

Lastly, we can use Micromedex Patient Education, as a standalone or embedded in the hospital EHR, to provide high-quality, evidence-based, consistent education to our patients. Health education resources are written in simple to understand language, an active voice, and at a 5th to 7th grade reading level. Patient-specific handouts and discharge instructions can be printed, and also made available to your patients via a patient portal and email.

Using Micromedex Solutions, we can compare internal benchmarks, which can be captured and quantified, to customize how pharmacy can improve care for patients. With these trusted solutions, we can make sure that the pharmacist and patient have all of the knowledge necessary to make informed decisions while aligning directly with HCAHPS standards. Well-honed tools help us adapt to the dynamic nature of the practice of pharmacy and no doubt solidify a blueprint for future regulatory and value based reimbursement programs.

Tina Moen, PharmD
Chief Clinical Officer

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