Faculty Bibliography

BACKGROUND:Since the establishment of the Hospital Readmission Reduction Program by the Centers for Medicare and Medicaid Services, reducing readmission rates has been a priority for health care institutions. Many institutions have developed services to combat high readmission rates, including bedside medication delivery programs, which have demonstrated reductions in 30-day readmission rates in patients who used these services. OBJECTIVE:To evaluate the impact of health system-based bedside medication delivery programs on readmission rates in patients at a low to moderate risk of hospital readmission. METHODS:A single-center retrospective cohort study conducted on adult patients of low-to moderate-transitions of care (TOC) risk status with unplanned admissions to a large academic medical center between January 1, 2017, and January 1, 2019 who used the medication bedside delivery service or an outside pharmacy. The TOC risk status was defined using historic institutional definitions. Patients with at least a 2-day hospital stay and who were discharged to home from select primary medical services were included. The primary outcome was 30-day readmission rates between the 2 groups. Secondary outcomes included 60- and 90-day readmission rates and readmission rates stratified by primary medical service and TOC status. Coarsened exact matching was used to account for variation between groups. RESULTS:The study evaluated 6583 patients discharged with a total of 3905 patients and corresponding index admissions meeting inclusion criteria for analysis. No statistically significant difference between readmission rates at 30 days after the index admission was found between the medication bedside delivery group and the outside pharmacy group, 7.97% and 10.09%, respectively (P = 0.136). However, the readmission rate of the medication bedside delivery group was statistically significantly lower than that of the outside pharmacy group at 60 and 90 days. CONCLUSIONS:This study suggests that bedside medication delivery programs do not significantly reduce readmission rates at 30 days but may do so at 60 and 90 days.

PURPOSE/OBJECTIVE:An interprofessional initiative to operationalize outpatient naloxone prescribing at a large academic medical center is described. SUMMARY/CONCLUSIONS:The initiative was carried out by a work group of clinical pharmacists and pharmacy administrators in collaboration with physicians and nursing staff leaders from multiple practice settings. An opioid overdose risk-assessment guide was developed on the basis of literature review and expert opinion. An institutional policy to guide identification of high-risk patient populations and facilitate naloxone prescribing and dispensing was developed and vetted by multiple expert committees. Patient education materials were created, and patients at high risk for opioid overdose were educated about overdose risk factors and naloxone use by a pharmacist and/or nurse before discharge or, in some cases, by outpatient pharmacists; when feasible, patients' friends, family members, and/or caregivers were included in education sessions. Interventions included distribution of a pamphlet emphasizing the importance of contacting emergency medical services personnel immediately in the event of an overdose, depicting the process for administration of injectable and nasal spray formulations of naloxone, and providing information on other first-response steps. Collaboration with outpatient pharmacies allowed for successful dispensing of naloxone prescriptions. CONCLUSION/CONCLUSIONS:The implementation of an outpatient naloxone prescribing policy at a large academic medical center created a streamlined approach for the interprofessional healthcare team to use in providing naloxone education and improved naloxone access to patients at high risk for opioid overdose.