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Impact of pharmacist-driven medication profile review, medication reconciliation and discharge education on 30-day hospital readmission

Lin, Karen (2019) Impact of pharmacist-driven medication profile review, medication reconciliation and discharge education on 30-day hospital readmission. Master Essay, University of Pittsburgh.

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Purpose: Transitions of care interventions are well documented to contribute to decreasing medication-related problems and readmissions. Consequently, healthcare facilities have implemented processes and models in efforts to address a public health need. Pharmacist-driven activities, such as medication history, medication reconciliation, medication profile reviews and discharge education have shown to contribute to reduced 30-day readmissions for patients who have an increased-risk for readmission.

Methods: Patients admitted to the 6th floor complex medical care unit at Allegheny General Hospital from November 2018 to February 2019 who were identified to be at an increased-risk for readmission were included. Patients were identified through our electronic health record predictive analytics model. These patients were followed through pharmacist-driven medication profile review, best possible medication history, admission and discharge medication reconciliation and discharge education. Patients were followed for 30-days post-discharge to assess the actual versus predicted readmission.

Results: The actual and predicted readmission rate was 46% and 47%, respectively. The actual and predicted rates appeared to be similar. This initiative included 107 patient admissions. Of these patients, 54% of patients were not discharged to home or self-care. On average, pharmacist made 4 interventions and spent 57 minutes per patient during the admission encounter.

Conclusion: There was no difference observed in actual versus predicted readmission. However, we were able to utilize this data and project to adjust pharmacist workflow through identifying technical barriers and reprioritizing responsibilities. A crucial step post-implementation will be to continue to evaluate to ensure processes are transforming to the public needs.


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Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Lin, Karenkal221@pitt.edukal221
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairBraund, Wendywendy.braund@pitt.eduUNSPECIFIEDUNSPECIFIED
Committee MemberFeingold, Daviddnf@pitt.eduUNSPECIFIEDUNSPECIFIED
Date: 18 September 2019
Date Type: Submission
Number of Pages: 34
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Multidisciplinary MPH
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Date Deposited: 20 Aug 2020 17:39
Last Modified: 20 Aug 2020 17:39


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