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When clinical pharmacists spend time talking with patients, the positive feedback goes up.
For hospitals, when it comes to improving quality of care and the overall patient experience, the stakes are high. In an era of changing approaches to healthcare reform, pharmacists have a unique opportunity to provide patient-focused initiatives across the continuum of care.
Germin Fahim“Interacting with their patients is likely the most critical way pharmacists can impact the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey,” said Germin Fahim, PharmD, clinical assistant professor, Ernest Mario School of Pharmacy and clinical pharmacist, internal medicine, Monmouth Medical Center (MMC), Long Branch, N.J.
In the HCAHPS questionnaire, the key areas in which pharmacists can affect patient care and patients’ perception of that care include pain management, discharge information, and medication communication. According to A. Scott Mathis, PharmD, MMC director of pharmacy, pharmacy worked with senior administration to add key resources over the last few years to target improvements in patient satisfaction and quality of care. A key element was getting more pharmacists to the units and directing their priorities.
Fahim believes that multidisciplinary rounds can help boost the hospital’s HCAHPS scores, because patients perceive a more collaborative approach to their care.
“A coordinated process helps to get all the healthcare providers on the same page, address any pain issues, and ultimately ensure that patients are comfortable,” said Fahim. During rounds with a pain management team, she recommends ways to optimize patients’ pain therapy with opiates and other analgesics. Important to the process is a review of each patient’s medication history, including a history of controlled drug use obtained from the state’s prescription drug monitoring program.
On the basis of their assessment, the pain management team will communicate any therapy-related recommendations to the patient’s primary physician.
“For example, if the patient is missing a medication that they were taking at home, we want to make the physician aware so that they can order it, because that often contributes to the pain,” said Fahim. “The patients are satisfied overall that we are merely checking up on them, even if they are not in any pain. Since initiation of the program about two years ago, pain satisfaction scores have increased approximately 30%. These improved HCAHPS scores has helped MMC to now rank higher, compared to nearby hospitals, in providing optimal pain control to patients.”
Fahim considers time spent with patients a vital opportunity for pharmacists to communicate medication-related information.
Pharmacy technicians also play a part. “Our pharmacy technician in the emergency room reviews profiles of new admits for documented medications, and collects and modifies medication history as needed,” said Fahim. This allows the pharmacists more time to talk to the patients about their meds. In addition, the nursing staff provides inpatients with medication cards that list therapy indications and their common side effects.
Fahim also pointed out a correlation between improved HCAHPS scores and scripted conversations with patients that include wording that matches HCAHPS survey questions. For example, “Hi, Mrs. Smith, I’m your [pharmacist/a pharmacy student working with your pharmacist], and I want to make sure you understand what your medications are for and their important side effects.”
The benefits and outcomes of a layer learner model (LLM) that uses pharmacy students as pharmacist extenders have been reported in a 2014 article in the American Journal of Health-System Pharmacy.
According to Osmel Delgado, PharmD, MBA, BCPS, FASHP, chief operating officer at Cleveland Clinic Florida in Weston, Fla., under the supervision of pharmacists, pharmacy students performed medication histories, education on drug indications and adverse effects, discharge counseling, targeted disease counseling, and profile review for drug-related problems for their patients.
Implementation of the LLM approach improved HCAHPS scores within the “communication of medication” domain, with the proportion of “always” responses increasing from 58% to 70%. In addition, increased overall pharmacy interventions and bedside medication-delivery capture rate were observed.
MMC uses the LACE index, which evaluates length of stay, acuity of the admission, co-morbidities, and emergency room visits in the previous six months, upon admission to flag patients who are at high risk for 30-day readmission.
“The decentralized pharmacists at our institution focus on these high-risk patients, including those with heart failure and pneumonia, when performing medication counseling and reconciliation at discharge,” said Fahim.
Monica Shah is a writer and hospital pharmacist in New Jersey.