OBJECTIVES

Transitions of care (TOC) involves the transfer of patient information between healthcare settings. Medication errors are prevalent in the TOC process and have a profound impact on health-system costs and health outcomes of patients, particularly in nursing home residents. Pharmacists’ expertise in medication safety can be utilized to improve the quality-of-life and health outcomes of nursing home residents. The purpose of the study is to determine the frequency as well as financial and clinical impact of therapeutic interventions by pharmacists during transitions of care in the long-term care (LTC) setting.

METHODS

TOC documents were completed by LTC staff pharmacists within 72 hours of a patient’s admission to the nursing home using FrameworkLTC, a pharmacy software program. Each TOC document was retrospectively analyzed and tagged either “No Recommendation” or “Intervention.” Frequency and type of interventions were documented and categorized. Additionally, nursing home residents’ health was assessed via a sample of 50 randomly selected patients. To further elucidate the impact of TOC recommendations from the nursing home’s perspective, a six-part questionnaire was sent to each director of nursing (DON). Data analysis was completed using SPSS.

RESULTS

From February 2018 through July 2019, 3229 TOC documents were retrospectively analyzed, resulting in 909 pharmacist interventions. The total cost for the pharmacists’ TOC time was estimated to be $43,193; thus, each pharmacist “intervention” cost $47.52. Results from the 50 nursing home residents indicated that the average number of medications (per patient) was 20.22 (range 10-39), with many patients receiving potentially harmful medications. Regarding the questionnaire, DONs responses demonstrated a strongly positive impact of the TOC recommendations.

CONCLUSIONS

This study showed that pharmacists play a central role in the success of the transitions of care process. Greater awareness of the implications of accurately managing TOC issues will contribute to reducing healthcare costs as well as improving patient outcomes.