By Melodie Zipfel, MSN, RN and Niki Carver, PharmD, CPPS
We know that “brown-bagging” a lunch can save money, but “brown-bagging” medications for a clinical review might just save a life.
To improve the nation’s health care system, the Centers for Medicare & Medicaid Services (CMS) is working to reduce readmissions and avoidable admissions by improving patient care transitions and the patient’s health care journey.
Research shows that one in five Medicare beneficiaries is readmitted to the hospital within 30 days after being discharged. But health system experts believe the problems associated with poor transitions of care and 30-day hospital readmissions are not solely the responsibility of community hospitals. Poor transitions often result from a breakdown in communication across the continuum of care.
To improve care transitions, TMF Health Quality Institute has partnered with the Arkansas Foundation for Medical Care (AFMC) and related organizations in other states to form a Quality Innovation Network Quality Improvement Organization (QIN-QIO), under contract with CMS.
As a result of the TMF partnership, nine Arkansas Care Transitions (ACT) coalitions have been established in the state. The coalitions include stakeholders from multiple health care settings who collaborate to address identified problems and improve care coordination. The coalitions serve 68 of Arkansas’s 75 counties, and represent 96% of the Medicare beneficiaries, as well as 96% of the state’s total population. ACT coalitions meet quarterly and have active subcommittees working toward change in their communities. The coalitions’ current focus includes chronic disease management, provider-to-provider communication and medication safety.
Medication safety issues have a strong impact on hospital readmissions. Medications influence nearly every aspect of a patient’s life. They are incorporated into an incredible 80% of treatments, whether for preventive, therapeutic, palliative or other goals.
Older Americans take nearly 35% of all prescriptions, with the average senior taking 14 prescription medications a year. Nearly 70% of people over age 65 make mistakes with their medications, according to studies. Medication errors range from overdose or taking inconsistent dosages, to omitting doses or having an irregular dosing schedule. Thirty percent of older Americans’ hospitalizations are due to adverse drug reactions. That places adverse drug reactions among the top five greatest health threats for people over age 65.
Knowing about all prescriptions your patients are taking – as well as over-the-counter drugs, vitamins, nutritional supplements and herbal medications they may be using – is vital to care and treatment outcomes. The best way to gain this knowledge is to conduct medication check-ups or “brown bag reviews.”
A medication check-up starts with encouraging patients to bring all their medications and supplements to medical appointments. This provides clinical staff the opportunity to review and discuss patients’ current medications.
Reviewing medications with your patients also helps you verify what they are taking, identify and avoid medication errors and drug interactions, answer their medication questions and assist patients with taking their medications correctly. Asking specific questions about a patient’s lifestyle, determining whether or not they have a caregiver and whether they use a pillbox for most of their medications can prevent medication errors. Medication compliance is of the utmost importance for good patient outcomes. There are no short cuts when it comes to proper drug therapy.
Brown bag reviews may also reveal whether patients are having difficulty obtaining their medications due to financial, social or transportation barriers. Once you identify barriers, you can help patients find ways to overcome them.
Conducting medication check-ups can be very helpful for practices. Most clinicians think it is a worthwhile endeavor. The challenge is getting patients to bring in all their medications, supplements, vitamins and herbal remedies.
It’s best to build awareness with a full-scale, practice-wide campaign to stress the importance of complete medication review. Open-ended questions, such as “tell me how often you take this medication,” can help with the conversation and with patient understanding. You can also use the teach-back method to make sure that patients understand your instructions and comments.
If you decide to start brown bag reviews at your practice, it will take some diligence to remind patients that you want to provide this review for them, and how important it is for their health and treatment. One way to promote this review is to provide special bags for patients to use when bringing their medications to appointments.
When you perform medications/supplements review, be sure to document your efforts in the patients’ records and confirm that medication lists are complete and current. Also, provide patients with written information on each medication they currently take.
Lastly, perform brown bag reviews at least annually and after any significant health event, such as a hospitalization. These efforts can reduce hospital readmissions and adverse drug events, enhancing patients’ quality of life.
Melodie Zipfel is an Outreach Specialist with AFMC. Niki Carver is Director of Pharmacy, Arkansas Continued Care Hospital and the TMF QIN-QIO’s pharmacy consultant.
The above article is from the Fall 2017 edition of Arkansas Hospitals, a quarterly magazine published by the Arkansas Hospital Association. Vowell, Inc. produces Arkansas Hospitals on behalf of the Arkansas Hospital Association. This article is reprinted with permission.