Pharmacists can lower readmissions with discharge counseling and housecalls

August 19, 2014

Why do discharge nurses tell patients to check with their pharmacists? Here's one answer - and the answer to quite a bit more.

Every pharmacist is a member of a healthcare team. Our primary purpose is to work with other healthcare team members; our shared objective is to ensure that the patient receives the best care we can possibly render.

Unfortunately, this level of care is slowly diminishing, as a result of the “I don't care” attitude of many healthcare providers, including pharmacists, who have become so overwhelmed with the other things they have to do that they cannot devote proper time to the patient.

The problem

I became involved in making house calls when the high rate of hospital readmissions became a matter of great concern to healthcare facilities and the U.S. government.

 

Pharmacist follow-up can reduce readmission rates of lower-risk Medicare patients

Here’s the usual process. Upon initial discharge, the patient is given prescriptions, usually by a nurse, who says, “If you have any questions ask your pharmacist.” The obvious problem, of course, is that unless the patient, caregiver, or someone in the family is in a healthcare profession, they don’t know what questions to ask.

Questions patients need to ask include:

·      “How do I take this medication?”

·      “When is the best time to take this medication?”

·      “Will these medications interfere with what I am currently taking [such as OTC, vitamins, herbals] or with any foods?”

·      “What side effects might I expect [especially with pain medications] and how can I minimize these effects?”

·      “Did the physician write as part of the instructions what the purpose of the drug is?”

 

The program

So I volunteered to set up a program for a local hospital. The plan was to ensure that during discharge, each patient would have the opportunity to discuss medications with a pharmacist.

Everyone was excited about this except the medical staff. As several nurses told me, “They are afraid that you might find an error, and that is the reason we tell patients to ask their pharmacists.”

I also perform chart reviews, and I always find errors, from minor to major. This prompted me to suggest that the healthcare agency I work with consider offering to provide a pharmacist to its clients to review their medications, for a nominal fee.

That’s how I got involved in making house calls.

Tutor and student

When I make house calls, I generally find that the amount of information that the patient lacks is mind-boggling. My initial visit is always a minimum of one hour. While I’m there, I make sure that the patient, caregiver, and family understand the patient’s disease state, as well as everything they need to know about the patient’s meds.

When I schedule a house call/counseling session, I ask to be sent a list of all the patient’s medications, OTC products, vitamins, and herbal products 48 hours in advance. Nobody wants to see you going to your iPad every time someone asks a question.

I approach each session as a tutor and I look upon the patient, caregiver, or family member as my class. I speak slowly, using language that is understandable, as opposed to the esoteric terminology you learned in school.

 

Improved wellbeing

Let me give three examples of how I have improved a patient’s wellbeing.

Other therapies. The first patient was an elderly client complaining of knee pain that woke him up at night. He wanted a knee replacement, but instead, the physician prescribed some powerful opiates. When I reviewed the patient’s chart, the first thing I looked for was whether it noted anything for constipation. The physician had forgotten to prescribe a stool softener. In addition, I suggested to the physician that the patient consult a knee specialist to determine whether a lubricant injection might alleviate the pain for a period of time. Consequently, patient got the injections, his pain is significantly decreased, and he is very happy that he can walk his dog.

Drug-food interaction. I had a patient who was taking Zocor in the morning along with half a grapefruit. He complained how heavy his legs felt. No one had told him that grapefruit is contraindicated with Zocor.

Anticoagulation. My last example is a patient who was prescribed 15 mg of Coumadin. He was also taking numerous herbal supplements that increased his prothrombin levels. I told him to take the Coumadin around 5PM and go completely off each supplement. Within a week he was down to 5 mg of Coumadin.

It is most rewarding when you see patients making progress and returning to their normal selves. I had a patient who was given four months to live. It is now well over a year, and the patient is back to full strength.

I also am asked to lecture to various groups. it is rewarding to see people in the audience whom I have helped, patients who would have been readmitted to the hospital otherwise and whose conditions most likely would have worsened.

 

The right temperament

Making house calls can be very gratifying, but you have to have the right personality to be effective.

The biggest complaint you hear from pharmacists is that the stress of their work environments does not allow them to counsel properly. Customers complain that they feel rushed when seeking answers.

Pharmacists who are not personable, who answer questions only with a yes or no, would not be a good fit for discharge patients and patients at home who are seeking complete answers.

You have to remember that you are dealing with the lives of people, that you are a member of a healthcare team working to ensure that the patient is receiving the best care possible.

Robert Katz has been a working pharmacist for 43 years and is still passionate about the profession. You can e-mail him atPharmrobert@gmail.com.