Patients returning home from Grand River Hospital (GRH) are benefiting from a Meds to Beds program, which delivers discharge prescriptions and patient education right to each patient’s bedside. Grand River Hospital’s in-patient and retail pharmacies as well as the director of medicine partnered to lead this innovative patient-centred program.
Health Quality Ontario had an opportunity to speak with Andrea Guth, Director of Quality and Performance Management, Nael Abumustafa, Director of Medicine and Waterloo-Wellington Stroke, and Lashen Naidoo, Manager of Retail Pharmacy to discuss how this program has led to better patient education, transitions in care, safety and experience.
Why did GRH create the Meds to Beds Program?
Andrea: The Meds to Beds Program was borne out of the desire to improve patients’ experiences at GRH. We had received feedback from patients that they were waiting a long time in retail pharmacies post discharge for their medications and we wanted to address this. We also know that transitions in care, such as hospital discharge, are a risky time in a patient’s journey. Patients want to be able to review their medications with a health care provider (see Health Quality Ontario’s Transitions in Care: What we Heard report).
We asked ourselves a question - “Can we provide discharge medications to patients before they are discharged and council them with medications in-hand?”
The answer was yes. GRH has a retail pharmacy on-site that is owned and operated by the hospital. This provided a unique opportunity to bring “meds to beds”.
One of the primary objectives of this program is to improve patient care by eliminating obstacles that patients face when filling their discharge prescriptions. These obstacles are often related to drug plan billing issues, which are very hard to predict at the hospital level. By addressing these issues before the patient leaves the hospital we have helped to ensure that the patients who have chosen this program are able to obtain all their discharge medication in a timely manner. This type of issue is definitely very prevalent in the discharge scripts that are filled via the Meds To Beds program.
Lashen Naidoo (centre) and team members at Health Care Centre Pharmacy
Can you describe how the Meds to Beds program works?
Nael: The Meds to Beds program is offered to patients on selected floors (Medicine, Surgery, and General Internal Medicine Rapid Assessment Clinic) by frontline staff prior to discharge. Processes and criteria were developed for each unit since each unit has different workflows and patient populations.
When patients opt into the program, a discharge medication reconciliation (MedRec) form is faxed to our on-site retail pharmacy with a discharge time. The medications on the discharge prescription are then prepared and a pharmacist delivers the medication and provides in-person counselling. This occurs either in the patient’s hospital room, our “discharge lounge,” or in the retail pharmacy depending on what the patient prefers.
A fax is then sent to the patient’s regular pharmacy to ensure communication and continuity of care. Patients are encouraged to see their physician within seven days of discharge.
The program initially started at the GRH’s KW Campus. It is now in place at the Freeport Campus, which provides care to longer-term patients in complex continuing care, rehabilitation and specialized mental health.
Here is our Meds to Beds Brochure and Flyer that provides information to patients about the program.
What benefits have you seen so far?
Lashen: Patients like the ease of leaving the hospital with medications in-hand and not having to make an additional stop.
Patient feedback on the Meds To Beds program has been very positive. Some of the comments we received are:
- “Worked well for me. No need to stop for meds at my regular pharmacy.”
- “Loved the service. Very convenient. Detailed info from the pharmacist.”
- “Wonderful service.”
- “A world of difference.”
- “Very kind staff.”
- “Explanation of meds was very detailed.”
Finally, if issues arise during medication preparation, it can quickly be clarified since doctors are on-site as opposed to community pharmacies that would need to reach out to a physician.
Did you face any challenges?
Nael: Our work implementing this program focused on:
- Buy-in from frontline staff;
- Managing change with respect to processes and workload among in-patient pharmacy and nursing staff members; and
- Deciding which patient populations should be included in program.
To address these challenges, we used a phased approach beginning with the medicine unit, which includes a more complex population, primarily older adults. We purposefully chose this population so that we could start slow, demonstrate the impact we could have on medication safety, share patients’ feedback and introduce the process of the program to staff.
Weekly reports showing the percentage of patients discharged using the program and patient feedback is continuously shared with staff and our Medicine Quality Council. We continue to have an increasing number of patients enrolled in the program and ongoing positive patient feedback.
What are your next steps?
Lashen: We continue to work with various units to clear hurdles to enrollment and to increase uptake of the program in our two hospital sites. We are also getting ready to trial the next phase of the program, which will include having a pharmacist do a home visit one week post discharge to check in on patients.
Do you work to improve medication safety in your organization? Share your comments and questions by clicking on “Add a Comment” below, or reach out to Nael Abumustafa or Lashen Naidoo, on Quorum.