Bridging gaps in care: Implementation of a pharmacist-led transitions-of-care program

The development and implementation of a hospitalwide, pharmacist-led transitions-of-care (TOC) program are described.

This 21-week quality improvement initiative was conducted from October 1, 2015, to February 26, 2016, at Memorial Hospital Pembroke. A TOC team was comprised of pharmacists, a pharmacy resident, pharmacy students, a physician, case managers, and nurses. All patients over the age of 18 admitted to the inpatient telemetry unit were included in this initiative. The primary endpoint was a sustained improvement in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores for "Communication About Medications" and "Care Transitions: Understood the Purpose of Taking Medications." Secondary outcomes included 90% of admission and 80% of discharge medication reconciliations reviewed by a pharmacist.

A total of 661 patients were included. The HCAHPS scores for "Communication About Medications" and "Care Transitions: Understood the Purpose of Taking Medications" had a sustained improvement during the study period. A pharmacist completed 94% and 75% of admission and discharge medication reviews, respectively, and a total of 1,579 interventions were made. Discharge education was completed at a rate of 73%.

After a quality improvement initiative developed by pharmacists was implemented, HCAHPS scores showed improvement and more patients received medication reconciliation.