Pharmacy Can Lead Heart Failure Transition-of-Care Programs

To win the health care relay race, one clinician needs to pass the baton to the next clinician, who must be ready to receive it.

This is the theory behind transitions of care, an area of emphasis for quality improvement.

One program developed at a 390-bed community teaching facility proves that pharmacists can take the lead in improving care transitions, at least for heart failure (HF) patients.

In a study published in the July 2015 issue of the Journal of the American Society of Health-System Pharmacists, pharmacists at the facility led a transitions-of-care program to reduce HF-related readmission risk and increase patient satisfaction.

They monitored for compliance with 3 core HF measures:

(1) Did patients receive discharge instructions?

(2) Was left ventricular systolic (LVS) evaluated?

(3) Was an ACE inhibitor or ARB prescribed for LVS dysfunction?

The pharmacists started with a committee structure that emphasized standardized workflow processes in 3 areas: conducting admission medication review, completing discharge medication review, and providing discharge counseling.

They calculated a readmission risk complexity score for all HF patients at admission. Then, pharmacy staff comprised of a pharmacist, resident, and student conducted daily medication profile reviews, looking for optimal doses of appropriate HF medications. They consulted with the prescriber when they found deviations.

The hospital provided reports from electronic medical records that predicted patient discharge, and the pharmacist remained vigilant for pending discharges. Pharmacy staff or a HF nurse navigator could then counsel each patient thoroughly.

At the study’s conclusion, core HF measure compliance improved, as did patients’ 30-day and all-cause readmissions. Patient satisfaction scores also improved.

In addition, each avoided HF-related readmission was associated with a decrease of $5652 in variable costs.