The document describes a study conducted at Waynesboro Hospital to implement a pharmacist-led discharge counseling program using lean principles. The objectives were to utilize existing resources to conduct discharge counseling and determine if it improved HCAHPS scores regarding "Communications about Medications". After implementing the program, the HCAHPS scores for that domain increased significantly from a baseline of 59.7% to a mean of 72.9% over four months, representing a statistically significant improvement with a p-value of 0.0170. The results indicate pharmacist-led discharge counseling can successfully enhance patient education and experience regarding medications.

1. § In
a
world
of
rising
health
care
costs
and
greater
emphasis
on
pa4ent
sa4sfac4on,
more
and
more
hospitals
are
looking
for
ways
to
improve
the
pa4ent
experience,
while
also
cu;ng
costs.
§ Hospitaliza4on
and
subsequent
discharge
home
oAen
involve
discon4nuity
of
care,
mul4ple
changes
in
medica4on
regimens,
and
inadequate
pa4ent
educa4on,
leading
to
medica4on
misadventures
and
avoidable
rehospitaliza4ons1.
§ Many
studies
have
proven
that
pharmacists
are
well-­‐qualified
to
iden4fy
and
resolve
medica4on-­‐related
problems
that
occur
as
pa4ents
transi4on
between
health
care
se;ngs,
as
well
as
facilita4ng
pa4ent
discharge
by
reconciling
medica4on
discrepancies2,3,4,5.
§ To
the
best
of
the
our
knowledge,
there
is
no
published
account
of
a
pharmacist-­‐led
discharge
counseling
program
based
on
lean
principles,
and
what
impact
it
may
have
on
the
Hospital
Consumer
Assessment
of
Healthcare
Providers
and
Systems
(HCAHPS)
score,
now
a
quality
control
measure
used
to
determine
hospital
reimbursement6.
INTRODUCTION
§ To
implement
a
pharmacist-­‐led
discharge
counseling
program
with
exis4ng
resources
using
lean
principles.
§ To
determine
if
there
is
a
sta4s4cally
significant
difference
in
the
Hospital
Consumer
Assessment
of
Healthcare
Providers
and
Systems
(HCAHPS)
“Communica4ons
about
Medica4ons”
domain
aAer
implementa4on
of
the
program.
OBJECTIVES
§ This
study
was
submiUed
and
approved
to
the
Waynesboro
Hospital
Ins4tu4onal
Review
Board.
§ Prior
to
implementa4on
of
the
discharge
counseling
program,
ac4on
teams
were
formed
to
iden4fy
possible
domains
of
improvement
using
lean
principles.
§ Originally
developed
by
Taiichi
Ohno
for
the
Toyota
Manufacturing
Company7.
§ The
ac4on
teams
iden4fied
that
the
HCAHPS
score
regarding
“Communica4ons
about
Medica4ons”
was
low,
and
aAer
collabora4ng
with
pharmacy,
originally
developed
a
plan
for
daily
inpa4ent
medica4on
educa4on
rounding.
§ It
was
no4ced
that
pa4ents
were
not
as
recep4ve
to
counseling/
educa4on
during
their
stay
as
they
were
at
discharge.
As
a
result,
a
pharmacist-­‐led
discharge
counseling
program
was
formed.
METHODS
RESULTS
§ Based
on
the
mean
data
collected,
the
implementa4on
of
a
pharmacist-­‐led
discharge
counseling
program
demonstrated
a
sta4s4cally
significant
improvement
in
HCAHPs
Survey
Scores
regarding
“Communica4ons
about
Medicines”.
§ Limita4ons
of
our
study
include
small
sample
size
and
limited
4me
since
implementa4on
of
the
discharge
counseling
program.
CONCLUSIONS
REFERENCES
Utilizing Lean Principles to Implement A Pharmacist-led
Discharge Counseling Program
Salma Tewfik, PharmD, Clint Pentz, PharmD, MBA, BCPS
Summit Health – Waynesboro Hospital
METHODS
Data collection was acquired via Press Ganey scores over a four month
period since the implementation of the program (July – October 2015).
The focus was on the “Communications about Medications” domain in
the HCAHPS survey specific for the Medical-Surgical Floor at
Waynesboro Hospital.
Definition of “top box” scoring: a system which reports the percentage
of patients who respond in terms of “Always” or the highest possible
ranking category.
The data was then compared and analyzed to baseline top box scores
from 2014 over a 12 month period, to identify if there was a statistically
significant improvement since the implementation of the program.
A two sided t-test was used to compare both sets of data, and a p value
< 0.05 was determined to be statistically significant.
This study is still ongoing, and we hope to collect 12 months worth of
data for 2015-16 to compare to baseline scores collected from 2014.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! !
Pharmacist!Discharge!Counseling!
Revised!Date:!8/16/15!
Pharmacy!
! ! Page!1!
Quality!Check! Safety!Precaution! Standard!WIP!
Purpose:!!!Help!patients,!caregivers,!and!family!have!a!better!understanding!of!their!medications.!!To!
improve!metrics!related!to!medication!education!and!readmissions!
Related!Policies/Evidence/SPDs:!!!HCAHPS/Press!Ganey!Medical/Surgical!
Operators:!!Clint!Pentz!and!Jarett!Logsdon! Expected!Cycle!Time:!!!
STEP!
!
TASK!DESCRIPTION!
!
TOOLS/SUPPLIES!
REQUIRED!
1.! Identify!patients!for!discharge!counselling:!!Alert!prints!when!a!patient!has!
discharge!orders!placed,!determine!if!patient!is!from!Medical/Surgical!and!
appropriate!for!counselling.!!Discharge!medication!counseling!will!only!take!place!
Monday!through!Friday!when!2!Pharmacists!are!staffing!
Daily!Patient!
Census,!EMR!
2.! Review!and!print!the!“Patient!Visit!Report”:!!Review!report!on!all!patients.!!Review!
for!duplicates!in!therapy!or!conflicting!medications,!report!issues!to!physician!
Patient!Visit!Report!
3.! Review!patient!history!to!aid!with!medication!counselling! EMR:!Progress!
Notes,!H&P!and!
Consults!
4.! Review!new!medications/changes/discontinuations!with!patient:!Counselling!may!
include!mechanism,!reason!for!use,!sideLeffects,!!proper!administration,!food!
considerations,!etc.!
Patient!Visit!Report!
5.! Review/verify!all!home!medications!with!patient!and!answer!patient!questions.!
Notify!discharging!nurse!that!medication!discharge!counseling!has!been!completed!
Patient!Visit!Report!
6.! Report!discrepancies!or!possible!errors!to!physician!for!clarification:!!If!error!is!
found,!report!changes!to!physician!and!fix!patients!copy!of!“Patient!Visit!Report.”!
Patient!Visit!Report!
7.! Document!medication!education!using!a!PCS!note!title!of!
“Medication!Discharge!Counselling”!
EMR!
8.! Assess!effectiveness! HCAHPS!
9.! !
!
10.! !
!
11! !
!
12.! !
!
13.! !
!
Discharge Counseling Standard Work Description
DISCUSSION
DISCLOSURES
30
40
50
60
70
80
90
100
Jul14
Aug14
Sept14
Oct14
Nov14
Dec14
Jan15
Feb15
Mar15
Apr15
May15
Jun15
HCAHPS- Communication about Medicines FY15
(top box trends)
Data Center-line Goal Trendline
Chart 1: Top Box Scores by Discharge (2014)
Chart 2: Top Box Scores by Discharge Data After Discharge Counseling Implementation
(2015)
Baseline
HCAHPs
“top
box”
score
for
Waynesboro
Hospital
prior
to
discharge
counseling
was
59.7%.
A
target
mean
score
was
calculated
to
two
standard
devia4ons,
giving
a
goal
score
number
of
77.4%.
AAer
implementa4on
of
pharmacist-­‐led
discharge
counseling
in
July
2015,
the
scores
increased
to
76.5%
aAer
the
first
month,
then
79.2%,
63.7%,
and
72.3%
for
August,
September
and
October
2015,
respec4vely.
A
two
sample
t-­‐test
was
u4lized
to
compare
this
new
data
to
the
baseline
score,
resul4ng
in
a
p
value
=
0.0170
(59.7%
vs.
72.9%)
Table 1: Pharmacist-led Discharge Counseling Target Progress Report
§ Based
on
data
collected
over
the
four
month
period
(July
–
October
2015),
a
pharmacist-­‐led
discharge
counseling
program
demonstrated
a
sta4s4cally
significant
improvement
in
HCAHP
scores
over
the
baseline
mean
score.
§ September’s
low
score
was
contributed
to
2
weeks
vaca4on
4me
for
Waynesboro
pharmacists,
where
no
discharge
counseling
was
performed
due
to
lack
of
resources.
§ Defects
associated
with
discharge
medica4ons
were
tracked
in
conjunc4on
with
top
box
scores.
AAer
a
pharmacist
completes
a
discharge
counseling
session,
any
errors
found
in
the
medica4ons
list
are
submiUed
to
the
Summit
Safety
Alert
repor4ng
system
and
listed
in
the
EHR
as
“error
preven4on”
(interven4on
type).
§ Examples
include:
pneumonia
pa4ent
was
not
prescribed
the
remaining
course
of
an4microbials
at
discharge,
pa4ent
with
a
hypertensive
emergency
had
medica4on
regimen
changes
during
their
stay
not
reflected
on
discharge
medica4on
list,
etc.
§ The
added
benefit
of
error
preven4on
at
discharge
poten4ally
avoids
readmissions
for
key
diagnosis
groups.
More
studies
are
needed
to
determine
this
benefit.
The
authors
of
this
presenta4on
have
nothing
to
disclose
concerning
possible
financial
or
personal
rela4onships
with
commercial
en44es
that
may
have
a
direct
or
indirect
interest
in
the
subject
maUer
of
this
presenta4on.
1. Schnipper
JL,
Kirwin
JL,
Cotugno
MC,
et
al.
Role
of
Pharmacist’s
Counseling
in
Preven4ng
Adverse
Drug
Events
AAer
Hospitaliza4on.
Arch
Intern
Med.
2006;166(5):
565-­‐
571
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PC,
Bernstein
SJ,
Tucker
Jones
JN,
et
al.
Impact
of
a
Pharmacist-­‐Facilitated
Hospital
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A
Quasi-­‐Experimental
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PJ,
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AB,
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BJ,
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JL.
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964
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A,
MacKinnon,
NJ
Roberts,
N
Saulnier
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iden4fied
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65-­‐
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JD,
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GG,
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Accessed
27
November
2015.
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Tom.
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Accessed
24
November
2015.