Project PRIMED (Pharmacist Reconciliation and Medication Education at Discharge)
Erika Smith, Pharm.D., Ryan Fleming, Pharm.D., Todd Karpinski, M.S., Pharm.D., Garret Newkirk, M.S., Pharm.D., BCPS, Siddhartha Singh, M.D., Jill Zimmerman, M.S., Pharm.D.
Froedtert Hospital & Medical College of Wisconsin, Milwaukee, Wisconsin
The hospital discharge process is complex and can become rushed and disorganized leaving patients vulnerable to medication errors and adverse drug events. The purpose of Project PRIMED (Pharmacist Reconciliation and Medication Education at Discharge) was to improve the quality of patient care at hospital discharge. Goals of the project were three-fold: 1) improve patient safety by reducing medication error through pharmacist intervention, 2) improve patient access to outpatient onsite pharmacies by eliminating barriers that delay the filling of discharge prescriptions, and 3) financially justify additional pharmacists for hospital-wide implementation of Project PRIMED by generating revenue for the onsite outpatient pharmacies.
Over the past decade, our pharmacy department has made significant advancements to the medication reconciliation process during transitions in care. In 2010, our focus shifted to assessing the impact of pharmacist-provided medication reconciliation and education at hospital discharge. A four-week pilot study was conducted to assess viability of the project. Based on data from the pilot study, hospital senior leadership supported the addition of two full time pharmacists to expand the service to four nursing units. Data collection, patient intervention stories, and error avoidance were recorded by the two PRIMED pharmacists.
Data from Project PRIMED was collected from September 1 through December 31, 2010. During the study period, 825 patients had a PRIMED encounter, equating to approximately 10 patients per day between the two pharmacists. Over half (52%) of these patients required at least one intervention to prevent a medication-related problem resulting in a total of 661 interventions, 46% of which potentially avoided patient harm according to the National Coordinating Council for Medication Error Reporting and Prevention Index for Categorizing Medication Error Algorithm. Utilization of the onsite outpatient pharmacies by patients at discharge was low prior to Project PRIMED. Approximately 9% of patients filled their discharge prescriptions at the onsite pharmacies. During Project PRIMED, 60% of patients who had a PRIMED encounter and had discharge prescriptions to fill chose to fill their prescriptions at the onsite pharmacies. The projected increase in annual prescription revenue totaled $192,145. The projected annual cost avoidance associated with the reduction in medication errors totaled over $1.1 million. Although not statistically significant, patient satisfaction ratings were higher on the PRIMED floors.
Medication reconciliation by a pharmacist at hospital discharge can reduce preventable medication errors. In addition, having pharmacists educate patients on their new medication regimen and facilitate the outpatient prescription acquisition process may improve patient access to outpatient prescriptions and increase patient satisfaction. Hiring additional pharmacists to allow for pharmacy discharge services can be financially justified by demonstrating an increase in outpatient prescription volume and overall healthcare cost avoidance.
View a pdf of the poster from the Midyear Meeting (930 KB)