Pharmacist’s Role in Transitions of Care TuTran Nguyen, PharmD PGY-2 Internal Medicine Pharmacy Resident IU Health- Methodist Hospital & Butler University This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.
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Pharmacist’s Role in Transitions of Care TuTran Nguyen, PharmD PGY-2 Internal Medicine Pharmacy Resident IU Health- Methodist Hospital & Butler University.
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Pharmacist’s Role in Transitions of Care
TuTran Nguyen, PharmD
PGY-2 Internal Medicine Pharmacy Resident
IU Health- Methodist Hospital & Butler University
This speaker has no actual or potential conflicts of interest to disclose in relation to this presentation.
Medication Discrepancies
Clev Clin J Gen Intern Med. 2010;25(5):441–7.
Question
• What percent of in-patient order errors arise from medication histories?
a. 25%b. 45%c. 65%d. 85%
Impact of Unintentional Discrepancies
Am J Health-Syst Pharm. 2004;61:1689-95. Clev Clin J Gen Intern Med. 2010;25(5):441–7. Am J Health-Syst Pharm. 2009;66:2126-3. Ann Intern Med. 2003;138:161-167.
Question• During which stages have pharmacist’s
intervention(s) resulted in positive impact on patient outcomes?
i. Admissionii. During hospitalization iii. After discharge
a. i & iib. ii & iiic. i & iii d. i, ii, & iii
Pharmacist’s Role
Am J Health-Syst Pharm. 2008;65:857-60. American Journal of Pharmaceutical Education. 2014;78:(2):Article 34:1-5. Arch Intern Med. 2003;163:2014-2018. Am J Health-Syst Pharm. 2009;66:2126-31. Arch Intern Med. 2009;169(21):2003-2010. Arch Intern Med. 2006;166:565-571.
Question
Which of the following characteristic is considered a risk factor for readmission?
a.Greater than 5 medications prior to admission
b.Age >50
c.Greater than 5 comorbid conditions at admission
d.Addition of 1 new medication at discharge
High Risk CharacteristicsCharacteristics
Age >70
Admission in previous months (3-6)
Marital status
>3 Comorbid conditions at baseline
Number of treatment specialists involved in patient’s care
Alcohol/substance abuse
Number of medications at discharge
Medications requiring therapeutic monitoring
Two medication therapies started, changed, or stopped during admission
Documented dementia or confusion at baseline
Documented non-adherence
Dependence on feeding tubes
Presence of pressure sores Arch Intern Med. 2009;169(21):2003-2010. Journal of Hospital Medicine. 2009;4:211–218. Proc (Bayl Univ Med Cent) 2008;21(4):363–372. Q J Med 2011;104:639–651.