Extending care beyond the four walls of the pharmacy

Transitioning from a nursing home back into the patient’s own home can be very stressful for the patient and for the family. Al Patel, a Medicine Shoppe owner in Whiting, NJ, continually saw patients and families experience this struggle and wanted to help. He set out to provide a service to help make the transition as easy as possible for all parties involved, through a program called Discharge Rx Care. This program was recognized at Cardinal Health’s 2015 Retail Business Conference in Las Vegas, Nevada, as a winner of the company’s 2015 Best Practice Competition for independent pharmacies. Here, we talk with Patel about Discharge Rx Care, and how it has helped his community lower hospital readmission rates while creating a successful business model for his pharmacy.

Q: What is Discharge Rx Care?

A: Discharge Rx Care is a solution that I provide to patients that makes the transition back into their home from a nursing care facility easy for the nursing home staff, the patient and the patient’s caregivers.  The program is divided into two parts. In part one, we work with the nursing home to prepare the medications for the patients prior to their discharge.  All the medications are packaged in special adherence packs for morning, noon, evening and bedtime doses with days labeled for easy administration. The most important part of the program is that the pharmacy visits the patient’s home and personally delivers the medications on the day of discharge. The pharmacist arrives with a special medicine box with picture of the pharmacy and a picture of the nursing home.

Once in the home, our staff reviews all of the medications with the patients and their caregivers in a comfortable, relaxed environment. We show instructional videos on iPads to the patients for devices such as insulin pens, nebulizers and inhalers, to ensure the patient fully understands the proper way to administer the medications. The pharmacist also completes a full reconciliation and cleans up the patient’s medicine cabinets, removing expired medications or those that could cause harmful interactions.  Our staff follows up with the patients on a weekly basis to answer questions or note any side effects of the medications.

Q: Why did you start this program?

A: My pharmacy is centralized in an area with a significant senior population, and we have numerous nursing homes/hospitals nearby.  I noticed a pattern every time a patient was discharged from a facility. The discharges frequently happened over the weekend, when family members were able to travel to help with the transition. When they would come to the pharmacy to pick up all the medications, the family members, often children of the patient, would feel confused about all of the parent’s medications. They would have a short period of time to try to understand and then an even shorter time to explain to their parents how to take the medications.  I came up with the idea for my discharge program because I knew there had to be an easier way.

Q: How has this program helped patient adherence? 

A: When we go into the home and review the prescriptions with the patients we find they are more receptive to the information. Previously, when the information was provided in the nursing home or in the pharmacy, the patient was often tired and anxious to get home. Once they are home, not only are they able to understand the information better, but the medications are packaged in a way that makes it easier for them to remember to take them. The weekly follow-up calls have helped as well, as they serve as a reminder and let us take control of refills for the patient.  We keep the script, and the patient takes the right drugs and the right time.

Q: What challenges have you faced? 

A: There are ongoing everyday challenges – at times we have several discharges at the same time. We stay in continuous contact with social workers and discharge managers in order to pre-plan and schedule accordingly. I have an extremely dedicated, courageous and passionate staff. I know that together there isn’t a challenge we can’t overcome as a team.    As a result of this practice, we are now a preferred discharge pharmacy for one of the ACO hospitals in New Jersey - which is a dream come true for us.

Editor’s note: To find more best practices in retail pharmacy, download the 4th edition of the Cardinal Health Best Practices magazine


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