Results of a Bedside MTM Service in a Community Hospital

Over the past 6 months I have had the opportunity to aid in the rollout of a very exciting program aimed at decreasing readmissions in a local community hospital.

If you have not been following my documentation of this program's implementation, you can read a previous article about it here.

It is important for me to realize that I am a single player on a large team, helping to move a program forward in an institution while constantly collaborating with many other team members. Every player has an important role, and it is most beneficial to have each perform the part he or she plays best.

We are now in the sixth month of our program's deployment, and to say that we have had not had any growing pains would be an understatement. Over those 6 months, the process has adapted and changed every couple of weeks to accommodate both our understanding of the flow of events, as well as the continuous building of our team with new members.

At the beginning of our program we had 2 specific goals in mind:

• Decrease 30-day readmissions among high-risk patients.
• Increase business for our outpatient clinic pharmacy.

Results

After 3 months, we were able to accumulate our first round of official data. The quarter of the year when we first implemented our bedside MTM program showed a 0.84% decrease in the 30-day readmission rate compared with the combined average of the previous 3 quarters. In context of only readmitted patients, the rate decreased by a full 8 percentage points, from a 10.67% 3-quarter average to 9.83%.

While other factors may be influencing the data, we are excited to see that our efforts may have provided a benefit to the hospital. It is important to note that, during this time, the pharmacist performing the daily visits was only able to see 1 or 2 patients each day. During the first 3 months of deployment, we visited a total of 56 patients. Since our first quarter, we have become more proficient at delivering the bedside MTM, so our goal in the future will be to provide MTM services to 4 or 5 discharge patients each day.

Fortunately, the data for our second overall goal was easy to measure. We compared the number of prescriptions filled throughout the 4 months prior to the bedside MTM program's implementation with the number of prescriptions filled throughout the 4 months following implementation of the program. The daily average of prescriptions filled at our outpatient pharmacy increased by 8.3%, so this is definately a success that will only continue to grow.

During the bedside MTM session patients are offered, as an alternative, the opportunity to pick up their discharge prescriptions at the hospital outpatient pharmacy when they are ready to go home. If the patients agree, we coordinate their insurance billing and fill their prescriptions for them. We are set up in our pharmacy so we may spend an ample amount of time with the patient or a family member in our counseling area discussing the medication regimen and reinforcing the information that the pharmacist had discussed with the patient at the bedside MTM visit.

Many patients are happy that we have time to spend with them at the counter discussing their medications. Subjectively, we have found that patients who are not satisfied with their current community pharmacy relationship will ask us if they may come back to our store for their follow-up and refills.

Transition

After 3 months of the bedside MTM program, we began to examine how the continuity of care in the outpatient pharmacy was affected. To do, we relieved a regular staff member for 4 hours every day, and we would have well-qualified relief pharmacists work in the outpatient setting to allow myself or my partner time to perform the 4-hour visit to the hospital. With the increased prescription volume, greater regulatory compliance issues, and patient relation issues that seem to arise on an hourly basis, we felt that the continuity of care would be well served to have the regular staff back in the outpatient pharmacy.

Two pharmacists from the hospital began to rotate through the 4-hour rounds and bedside MTM shift each morning with excellent success. After a few weeks of shared rotations, the 2 pharmacists from the hospital setting developed skills in patient communication and counseling, and they are currently providing the valuable service. Both of the pharmacists have spent time working in our outpatient setting so they may gain an understanding of prescription insurance issues, as well as be available for relief coverage when necessary.

Future

Up until now, the program has been funded through a small surplus of time available through the hospital pharmacy. We were all concerned that, even though the program shows value, it may not meet approval from administration as a continued service. This past week, our new Director of Pharmacy for the hospital received approval from administration to continue the 4 hours per day program.

With innovative foresight, our new director created a position which will allow 1 of the hospital pharmacists to continue delivering bedside MTM services to inpatients on the selected units, and then maintain clinical and order entry function on the same unit for the remainder of his or her shift.

This is the beginning of a strong sense of continuity of care by the hospital pharmacist on a specific unit. The pharmacist working on the unit will maintain a significant connection with our outpatient pharmacy so that we may be in a position to support each other whenever necessary.

In the near future, the pharmacist on the unit may help coordinate the discharge orders being sent to the outpatient pharmacy, allowing enough time for us to put the orders together and have a technician deliver them to the patient’s bedside. With a point-of-care handheld device, the technician will then enter the patient’s payment information as well as gather any necessary signatures. The pharmacist on the unit may then meet with their patient and discuss his or her medications.

With the program now running in the hospital, we have time to develop and implement an appointment-based model (ABM) medication synchronization program in the outpatient setting. The ABM will shift the focus from passively filling prescriptions at the request of patients to a synchronized and proactive schedule. This process will involve a monthly or every-third-month appointment with the patient, allowing the pharmacist an opportunity for a full review of all medications, as well as identifying any compliance or therapeutic issues that a patient may be facing. This face-to-face appointment with the patient may also provide an opportunity to address any MTM possibilities, such as an annual complete medication review.

Our new goal will be to work with each other as a health care team, maintaining a successful transition of care from the inpatient to the outpatient setting. This process has the potential to provide an unprecedented continuity of care.