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Improving inpatient discharge workflows through pharmacist pending discharge medication orders
Kasheng Lee1, Grace Nixon2, Kristin Niemi1
1Department of Pharmacy, University of Wisconsin Health, Madison, WI, USA.
Summary
A new pharmacist-led discharge process, involving pended medication orders, significantly reduced medication-related problems by 52.4%. This enhanced workflow improves hospital discharge efficiency and patient safety.
Area of Science:
- Health Sciences
- Clinical Pharmacy
- Patient Safety
Background:
- Hospital discharge is a critical care transition prone to medication-related problems (MRPs).
- Medication reconciliation is a key strategy to mitigate MRPs.
- Current workflows often involve inefficient, duplicative pharmacist interventions post-provider reconciliation.
Purpose of the Study:
- To evaluate a prospective pharmacist-led pilot program for discharge medication orders (pended orders).
- To determine the program's impact on MRPs and discharge processing time.
Main Methods:
- A prospective pilot study comparing a pharmacist-led workflow with pended orders against standard discharge workflows.
- Data collected from two hospital medicine services over three months.
- Measured clinical interventions and time from order entry to final reconciliation.
Main Results:
- The pilot group showed a significant 52.4% decrease in pharmacist clinical interventions post-provider orders (P = 0.03).
- A nonsignificant 47.6% reduction in time to final pharmacist reconciliation was observed.
- The pharmacist-led approach enhanced overall discharge efficiency.
Conclusions:
- Pharmacist-led discharge medication reconciliation with pended orders improves efficiency.
- Findings support an expanded role for pharmacists in discharge processes.
- Emphasizes the need for strong pharmacist-provider collaboration.
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