Transitioning patients from acute care settings to skilled nursing facilities (SNFs) is a complex process, particularly concerning medication management. Delays and errors during this transition can significantly impact patient safety and lead to adverse health outcomes, including hospital readmissions. A critical area of focus is ensuring timely administration of medications, especially high-risk ones, upon arrival at the SNF.
Recognizing these challenges, a health system initiated a comprehensive evaluation of its hospital-to-SNF transition process. A multidisciplinary team was assembled to investigate the frequency of missed medication doses and pinpoint the underlying causes of medication administration delays. A retrospective analysis of patient transfers from a community hospital to an SNF between January and June 2017 revealed a concerning statistic: 60% of initial doses of high-risk medications were administered after their scheduled time. A primary obstacle identified was the lag in entering medication orders into the SNF’s electronic health record upon patient admission. Furthermore, the 30-day readmission rates for these patients were exceeding the established targets, highlighting the need for process improvement.
To address these identified gaps, a targeted, pharmacist-led pilot program was designed and implemented. This Transition To Acute Care Program focused on enhancing medication management during the crucial transfer period. The program was rolled out across the same two hospitals and SNF sites evaluated in the baseline study, spanning from March to May 2018. A key component of this program involved a pharmacist proactively reviewing, reconciling, and entering medication orders before the patient’s arrival at the SNF. This intervention aimed to eliminate order entry delays and streamline the medication administration process.
The impact of the pharmacist-led transition to acute care program was substantial. Post-implementation, delays in medication order entry were effectively eliminated. Moreover, the average time delay between the scheduled medication time and actual administration was reduced by an impressive 68% compared to the baseline data. In addition to addressing delays, the program also focused on medication accuracy. Analysis of discharge summaries for 51% of transferred patients uncovered medication errors. Crucially, the pharmacist intervention facilitated the clarification and resolution of these errors before SNF admission, preventing potential downstream issues. Beyond medication administration improvements, the program also demonstrated a positive impact on patient outcomes. The 30-day all-cause readmission rate following SNF transfers during the pilot program decreased by 10.4% compared to the same period in the previous year, suggesting a broader benefit to patient stability and care continuity.
In conclusion, the implementation of a pharmacist-led transition to acute care program for medication management during hospital-to-SNF transfers yielded significant improvements. The program effectively mitigated key barriers such as delayed medication administration and medication order entry. Furthermore, by proactively addressing and resolving discharge medication errors, the program enhanced medication safety and contributed to a notable reduction in 30-day readmission rates. This model underscores the critical role of pharmacists in optimizing care transitions and improving patient outcomes in the complex landscape of post-acute care.
