Enhancement of a pharmacy consultation program on a transitional care unit

Area of Science:

• Pharmacy Practice
• Health Services Research
• Patient Safety

Background:

• Transitional care units (TCUs) manage complex patient populations requiring comprehensive medication management.
• Pharmacy consultation programs are vital for optimizing medication therapy and preventing adverse drug events.
• Previous pharmacy interventions on TCUs showed potential but required enhancement for greater impact.

Purpose of the Study:

• To describe the revision of a pharmacy consultation program on a transitional care unit (TCU).
• To evaluate the outcomes of the revised program compared to the original program.
• To assess the impact of enhanced pharmacist involvement on patient care and cost-effectiveness.

Main Methods:

• A pharmacy consultation program on a TCU was revised in 1996.
• Changes included increased medication reviews, mandatory pharmacist participation in interdisciplinary meetings, simplified forms, and expanded physician education.
• Data from the two years before and two years after the revision were compared.

Main Results:

• Drug-related problems identified per admission increased from 0.32 to 0.80.
• Percentage of patients receiving a pharmacy medication review rose from 70% to 99%.
• Pharmacist recommendations increased from 140 to 726, with an acceptance rate of 82% (vs. 55%).
• Estimated cost savings were $15,000 in year 1 and $23,000 in year 2.

Conclusions:

• Revision of the TCU pharmacy consultation program significantly improved the identification of drug-related problems.
• Enhanced pharmacist integration into the interdisciplinary team led to more recommendations and higher acceptance rates.
• The revised program demonstrated positive impacts on patient care and generated modest cost savings.