Patients often struggle with managing their medications after hospital discharge, and it is estimated that up to 40% of discharge prescriptions go unfilled. For institutions without an inhouse discharge pharmacy, novel solutions are needed to provide patients with better access to discharge medications.
To implement a multidisciplinary medication pick up and delivery program, “Brown Bag Meds,” in order to increase access to medications at discharge.
As part of a BOOST care transitions intervention, follow up phone calls on the medicine service at a 600 bed academic medical center, from January 2011 to June 2011 were audited to determine the number of patients who had not filled new medications within 72 hours of discharge (Figure 1.) Based on this data, a multidisciplinary team of physicians, nurses and pharmacists in collaboration with a local pharmacy intervened on a single unit, to identify and provide patients with medications at discharge. Using staff meetings and morning reports, nurses and residents were trained to identify patients that would benefit from discharge medication delivery. The patients targeted were elderly, had limited mobility, had an urgent need for the prescription (e.g. antibiotics or insulin) or a history of poor medication adherence. Patients were generally identified first by nurses and communicated to house staff via a flag in the chart. Patients were approached for their agreement and preferences on medication pick up or delivery. Prescriptions were sent by fax and receipt was confirmed by a phone call from the unit clerk and bedside nurse. In the first few months of the program, from September 2011 to November 2011, approximately 38 patients on the unit received discharge medications though the Brown Bag Meds Program, 14 (37%) with delivery and 24 (63%) for pick up. No additional FTE or resources were needed for implementation. Through multiple performance improvement cycles we simplified the process of notifying house staff of eligible patients, linked this program with a preexisting Pharmacy Discharge Consult Service and applied for funds to cover copays and to include uninsured patients.
The inability to obtain timely discharge medications increases a patient’s risk for preventable adverse events after discharge. In collaboration with a local pharmacy, we implemented a program to improve access to discharge medications. Secondary benefits of this program include early verification of insurance coverage, increased opportunity for pharmacy teaching on delivered medications, and housestaff education about risk factors for and prevention of medication related adverse events after discharge.
Figure 1Patient ability to fill medications after discharge.
To cite this abstract:Monetta C, Kynoch E, Tam E, Quinn K, Le L, Mourad M, Jue V. Brown Bag Medications: Development and Implementation of a Program to Provide Discharge Medications. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97701. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/brown-bag-medications-development-and-implementation-of-a-program-to-provide-discharge-medications/. Accessed March 28, 2020.