Virtual medication reconciliation on discharge coming to hospitals

To support small and rural hospitals with patients transitioning from hospital to home, Northwest Telepharmacy Solutions (NTS) is launching their Virtual Medication Reconciliation on Discharge (VMRD) program to several hospital clients across Ontario.

The VMRD program will build on evidence-based literature supporting the role of a hospital pharmacist involved with medication reconciliation and counseling on discharge, including follow-up with patients in their homes within 72 hours of transition out of the hospital.

“Recent studies have shown a significant decrease in hospital readmission and ER visit rates following discharge when a pharmacist conducts discharge medication reconciliation and provides patient counselling,” says Kevin McDonald, pharmacist, founder, and Director at NTS.

“We have a unique opportunity to use our skills and expertise to be more actively involved with patients and their providers to help reduce the number of unintentional medication discrepancies which occur during transition to home.

Use of virtual technologies for video chats – or simply a phone call – offers a tremendous opportunity to improve care and reduce strain on the healthcare system overall.”

NTS has been providing remote hospital pharmacist services for over 15 years and currently services more than 60 hospitals across Canada, 24/7, 365 days a year.

NTS’s delivery model helps provide access to remote hospital pharmacists during the day to free up on-site hospital pharmacists to be more involved with clinical decisions; during the evening to extend pharmacy service hours; and overnight to help review in real-time physician orders entered in computer prescriber order entry (CPOE) models.

As hospitals transition to more sophisticated medication and care tracking tools such as CPOE, electronic medication administration records (eMARs), bedside medication verification (BMV) and a host of other technological upgrades, the role of the pharmacist to ensure accuracy and safety around the clock increases.

Ontario Health has released their Quality Statements for Transitions between Hospital and Home with emphasis on patients having their medication reviews on admission, on discharge, and once they are home. The medication reviews would include medication reconciliation, adherence, and optimization, as well as ensuring patients know how to use their medications.

Currently most hospitals are challenged to hire and fund pharmacists to provide a comprehensive Medication Review with Reconciliation program at admission, transfers of care, and discharge seven days a week despite the growing evidence to have pharmacists actively involved in the process.

Recent studies utilizing hospital pharmacists to teach patients at the bedside the medication uses (and changes) that occurred during their hospital admission with follow up by phone or video call after discharge to ensure understanding of those changes were the key factors to reduced hospital re-admission at both 30 days and 180 days by 30 percent.

Sammu Dhaliwall, pharmacist and Senior Manager of Business Development with NTS, explains how NTS will be remotely involved within the medication review process.

“We have access to secure virtual care technology allowing our pharmacists to have real-time face-to-face conversations with patients during their hospital stay. Incorporating the virtual care technology prior to the patient leaving the hospital, our pharmacists can converse and educate the patient all while reconciling their discharge medication list.”

To test the feasibility of delivering a VMRD program, NTS first conducted a pilot study at Lady Dunn Hospital in Wawa, Ont., where pharmacists interviewed patients that were at high risk of a medication-related adverse event upon hospital discharge using a telerobot – real-time mobile videoconferencing.

Following a discharge medication review by a pharmacist, each patient was provided with an accurate discharge medication list and counselled on their medications.

“We found the virtual interview was a positive experience for 80 percent of the patients,” says Paula Newman, Research Specialist and clinical pharmacist at NTS. “78 percent of patients had at least one error in their discharge medication list which was caught by the pharmacist before the interview even happened. Most of these errors on the discharge medication list were a missing medication.”

“Implementation of the discharge medication reconciliation program using a telerobot demonstrated remote hospital pharmacists are able to assess medication therapy, resolve medication-related issues and communicate with patients and their providers about their medications while in hospital before discharge.”

Starting in the spring 2020, NTS will be delivering the VMRD program at five hospitals across Ontario with the goal to expand to over 15 hospitals by end of the year, including larger sites.